TEST BANK
Chapter 01: The History and Interviewing Process Test Bank—Nursing MULTIPLE CHOICE 1. The primary objective of the initial encounter is to: a. define the advice and care for the patient. b. establish the tone of a successful partnership. c. optimize your ability to help. d. tell the patient the limits of care. ANS: B
The first meeting with the patient sets the tone for a successful partnership. It is to discover the details about patients’ concerns, explore expectations for the encounter, display genuine interest, and develop a partnership. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 1 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 2. If language is a barrier, the interpreter should be: a. a family member. b. a language board. c. a professional interpreter d. a staff person. ANS: C
Someone other than a family member should act as an interpreter to bridge the language difference between a health care provider and the patient. A professional interpreter rather than a family member should be used. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 4 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 3. Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more
and does not hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle: a. “Do you want to see a counselor today?” b. “Is your father out of jail yet?” c. “Are you taking any illegal drugs?” d. “Have you made plans to harm yourself?” ANS: D
If you sense that a patient is contemplating suicide, you should ask about suicidal ideation directly. The most important area to address is the potential for suicide. The question “Is your father out of jail yet?” may be relevant to the history, but is not an immediate concern. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. Ms. Yale is a 52-year-old patient who presents to the office for evaluation. During the
interview, you say “Tell me what you do when you have knee pain.” The health care provider is asking information about: a. health promotion. b. the description and character of the complaint. c. the location and duration of the complaint. d. aggravating and relieving factors of the complaint. ANS: D
The health care provider is asking a symptom-analysis question to obtain more information about the aggravating and alleviating factors of the knee pain. Asking the patient to describe a typical attack of pain would help obtain information about the description and character of the complaint. The question “When did you last feel well?” would help define the time of onset and duration of the complaint. A question about health promotion would be directed toward improving patient health. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 11 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Which question would be considered a “leading question?” a. “What do you think is causing your headaches?” b. “You don’t get headaches often, do you?” c. “On a scale of 1 to 10, how would you rate the severity of your headaches?” d. “At what time of the day are your headaches the most severe?” ANS: B
Stating to the patient that he or she does not get headaches would limit the information in the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an openended question. Asking the patient how he or she would rate the severity of the headaches and asking what time of the day the headaches are the most severe are direct questions. DIF: Cognitive Level: Applying (Application) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. To prevent personal appearance from becoming an obstacle in patient care, the health care
professional should: a. wear a uniform. b. avoid wearing white. c. avoid extremes in dress. d. avoid wearing any jewelry. ANS: C
Sensible personal habits, along with avoidance of extremes in behavior and dress, contribute to establishing a trusting relationship between the care provider and the patient. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 3 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Which action would best promote accurate translation and confidentiality when the caregiver
does not speak the patient’s language? a. Ask a person unfamiliar with the patient to translate. b. Have a friend of the patient translate.
c. Involve the family with the translation. d. Use a neighbor as translator. ANS: A
When you do not speak the patient’s language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger will be a less biased interpreter. You should ask a person unfamiliar with the patient to translate. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. When are open-ended questions generally most useful? a. During the initial part of the interview. b. After several closed-ended questions have been asked. c. While designing the genogram. d. During the review of systems. ANS: A
Asking open-ended questions at the beginning of an interview allows you to gather more information and establishes you as an empathic listener, which is the first step of effective communication. Interviewing for the purpose of designing a genogram or conducting a review of systems requires more focused data than can be more easily gathered with direct questioning. Asking closed-ended questions may stifle the patient’s desire to discuss the history of the illness. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Behaviors that diffuse anxiety during the interview include: a. avoiding wearing uniforms or laboratory coats. b. providing forthright answers to questions. c. providing all necessary information before the patient has to ask for it. d. completing the interview as quickly as possible. ANS: B
To relieve anxiety, the health care professional should answer patient questions forthrightly, should avoid an overload of information, and should not hurry the conversation. Uniforms, lab coats, and scrub suits are common in health care. It is impossible to anticipate every question that a patient may ask. Completing the interview as quickly as possible may make the patient feel rushed. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Periods of silence during the interview can serve important purposes, such as: a. allowing the clinician to catch up on documentation. b. promoting calm. c. providing time for reflection. d. increasing the length of the visit. ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning courage, and displaying compassion. This is not a time to document in the chart, but rather to focus on the patient. Periods of silence may cause anxiety rather than promote calm. The length of the visit is less important than getting critical information. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Which technique is most likely to result in the patient’s understanding of questions? a. Use phrases that are commonly used by other patients in the area. b. Use the patient’s own terms if possible. c. Use the simplest language possible. d. Use proper medical and technical terminology. ANS: B
To ensure that your questions have been correctly understood, be clear and explicit while using the patient’s own terms and level of understanding. Using phrases commonly used by other patients may not help ensure that your questions have been correctly understood by this patient. You should be clear and explicit while using the patient’s own terms and level of understanding. Using the simplest language will not help ensure that your questions have been correctly understood. It is important to avoid the use of medical terminology, because the patient may not understand it. DIF: Cognitive Level: Applying (Application) REF: p. 2 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr.
Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? a. “After 3 days, you’re tired of coughing. Have you had a fever?” b. “I’d like to hear more about your experiences. Where were you born?” c. “I don’t know what’s wrong. You could have almost any disease.” d. “I’ll examine you and figure out later what the problem is.” ANS: A
“After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at focusing on the chief compliant to gather more data and does not digress from the issue. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Mr. Miller is a 46-year-old patient who becomes restless during the history and says, “I don’t
have time for all of this conversation. I’ve got to get back to work.” Your most appropriate response would be to: a. remember (acknowledge) his anger and proceed with the history and examination. b. ask another open-ended question and insist on an answer. c. ask questions about his anger and move closer to him. d. ignore his displeasure and become more assertive about getting answers. ANS: A
Acknowledging his anger and proceeding with the history and examination is the only response that resists the tendency for patient manipulation, pursues the information, and confronts the anger. DIF: Cognitive Level: Applying (Application) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. When you are questioning a patient regarding alcohol intake, she tells you that she is “only a
social drinker.” Which initial response is appropriate? a. “I’m glad that you are a responsible drinker.” b. “Do the other people in your household consume alcohol?” c. “What amount and what kind of alcohol do you drink in a week?” d. “If you only drink socially, you won’t need to worry about always having a designated driver.” ANS: C
“What amount and what kind of alcohol do you drink in a week?” clarifies the patient’s own statement without asking a leading question or being judgmental. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 8 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Ms. T is crying and states that her mother couldn’t possibly have a tumor. “No one else in the
family has ever had cancer!” exclaims the daughter. The most appropriate response to Ms. T would be: a. “Has anyone explained hospice care to your mother?” b. “I’m so sorry that your mother was diagnosed with cancer.” c. “That is odd, since cancer usually runs in families.” d. “Why do you think that your mother’s tumor is cancerous?” ANS: D
“Why do you think that your mother’s tumor is cancerous?” is the only answer that is a direct exploration of the daughter’s concern. The health care provider can address and clarify the concerns of the daughter. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. After you ask a patient about her family history, she says, “Tell me about your family now.”
Which response is generally most appropriate? a. Ignore the patient’s comment and continue with the interview. b. Give a brief, undetailed answer. c. Ask the patient why she needs to know. d. Tell the patient that you do not discuss your family with patients. ANS: B
Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without invading your private life. Ignoring the patient’s comment, continuing with the interview, and telling the patient that you do not discuss your family with patients will potentially anger or frustrate her and keep her from sharing openly. Asking the patient why she needs to know will distract from the real reason she is seeking care and instead move the interview conversation away from the topics that should be discussed.
DIF: Cognitive Level: Applying (Application) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She
seems nervous as she speaks to you. An appropriate response is to: a. continue to collect information regarding the chief complaint in an unhurried manner. b. finish the interview as rapidly as possible. c. ask the patient to take a deep breath and calm down. d. ask the patient if she wants to wait until another day to talk to you. ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. If you as the health care provider are hurried, the patient will be more anxious. The best way to assist an anxious patient is to not hurry and remain calm, because this will communicate caring to the patient. Asking the patient if she wants to wait until another day to talk to you delays the needed health care. DIF: Cognitive Level: Applying (Application) REF: p. 4 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Ms. A states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one
of the following statements is the most appropriate caregiver response? a. “Try to think about the good things in life.” b. “What in life is causing you such pain?” c. “You can’t mean what you’re saying.” d. “If you think about it, nothing is worth getting this upset about.” ANS: B
Specific but open-ended questions are best used when the patient has feelings of loss of selfworth and depression. “Try to think about the good things in life,” “You can’t mean what you’re saying,” and “If you think about it, nothing is worth getting this upset about” are statements that will hurry the patient and offer only superficial assurance. DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 4-6 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially,
you should: a. ask him if he would like some time alone. b. offer a tissue and let him know it is all right to cry. c. explain to the patient that you will be able to help him more if he can control his emotions. d. ask the patient what he is upset about. ANS: B
When patients cry, it is best to allow the moment to pass at the patient’s pace. If you suspect a need to cry but the patient is suppressing it, give permission. Asking him if he would like some time to himself will leave the patient alone during a time of sad feelings. Explaining to the patient that you will be able to help him more if he can control his emotions will shut down the patient’s emotions. Asking the patient what he is upset about will not give the patient time to cry and express his emotions. DIF: Cognitive Level: Applying (Application) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. During an interview, you have the impression that a patient may be considering suicide.
Which action is essential? a. Ask whether the patient has considered self-harm. b. Avoid directly confronting the patient regarding your impression. c. Ask whether the patient would like to visit a psychiatrist. d. Record the impression in the patient’s chart and refer the patient for hospitalization. ANS: A
If you think the patient may be considering suicide, he or she probably is. Mentioning it gives permission to talk about it. Do not avoid directly confronting the patient regarding your impression. It is important to confront the suicidal thoughts. Asking whether the patient would like to visit a psychiatrist does not allow the patient to talk about the suicidal thoughts before you determine that she or he needs a specialist level of care. Recording the impression in the patient’s chart and referring the patient for hospitalization does not collaborate with the patient and does not give him or her permission to talk about the thoughts of self-harm. DIF: Cognitive Level: Applying (Application) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. During a history-taking session, Mr. B appears to be avoiding certain questions. He keeps
looking out the window. What should the caregiver do? a. Ask direct questions and insist on a “yes” or “no” answer to each question. b. Continue to ask questions until Mr. B responds appropriately. c. Make a note to pursue sensitive issues later in the interview. d. Stop the interview until the patient is ready to cooperate. ANS: C
When the patient dissembles, do not push too hard for an answer. Allow the interview to go on and come back to the questions he avoided answering later. Yes or no questions will close the interview process. Continue with the interview, making a note to return to questioning about that issue later in the interview. Continuing to ask questions until Mr. B responds appropriately will not allow the patient time to reflect and answer. Stopping the interview until the patient is ready to cooperate will stop the flow of communication. DIF: Cognitive Level: Applying (Application) REF: p. 5 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they should be:
a. given the opportunity to be interviewed without the parent at some point during the
interview. b. mailed a questionnaire in advance to avoid the need for them to talk. c. ignored while you address all questions to the parent. d. allowed to direct the flow of the interview. ANS: A
The older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice. Mailing a questionnaire in advance to avoid the need for her to talk does not assist the child in learning to respond to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored while you address all questions to the parent, the patient will feel as though she is just being discussed and is not part of the process for the health care. The health care provider should always direct the flow of the interview according to the patient’s responses. DIF: Cognitive Level: Applying (Application) REF: p. 16 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Information that is needed during the initial interview of a pregnant woman includes all the
following except: a. the gender that the woman hopes the baby will be. b. past medical history. c. health care practices. d. the woman’s remembering (knowledge) about pregnancy. ANS: A
The initial interview for the pregnant woman should include information about her past medical history, assessment of health practices, identification of potential risk factors, and assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is not as important as the information about her past medical history, health care practices, and the woman’s remembering (knowledge) about her pregnancy. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 17 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. When communicating with older children and teenagers, you should be sensitive to their: a. desire for adult companionship. b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk. ANS: D
Adolescents are usually reluctant to talk; therefore the provider should clearly communicate a respect for confidentiality. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 16 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. When interviewing older adults, the examiner should: a. speak extremely loudly, because most older adults have significant hearing
impairment. b. provide a written questionnaire in place of an interview.
c. position himself or herself facing the patient. d. dim the lights to decrease anxiety. ANS: C
The health care provider should position himself or herself so that the older patient can see his or her face. Shouting distorts speech, dimming the lights impairs vision, and a written interview may be necessary if all else fails. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 18 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When you suspect that your 81-year-old patient has short-term memory loss because he
cannot remember what he had for breakfast, you should: a. order a neurology consult. b. stop all of his medications. c. validate the concern with his family or caregivers. d. dismiss the finding as a normal age-related change. ANS: C
When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps. You may want to consult neurology later, but to assess the memory loss, you need validation of the patient’s responses. Stopping medications will not identify the short-term memory loss. Short-term memory loss is not an age-related change. DIF: Cognitive Level: Applying (Application) REF: p. 19 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. To what extent should the patient with a physical disability or emotional disorder be involved
in providing health history information to the health professional? a. The patient should be present during information collection but should not be addressed directly. b. All information should be collected from past records and family members while the patient is in another room. c. The patient should be involved only when you sense that he or she may feel ignored. d. The patient should be fully involved to the limit of his or her ability. ANS: D
Patients who are disabled may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Patients should be addressed directly and participate in the interview to the extent of their ability. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 20 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. A brief statement of the reason the patient is seeking health care is called the: a. medical history. b. chief complaint. c. assessment. d. diagnosis.
ANS: B
The chief complaint is a brief statement of why the patient is seeking health care. The medical history, assessment, and diagnosis are not the reasons that the patient is seeking health care. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 10 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. A pedigree diagram is drafted for the purpose of obtaining: a. sexual orientation and history. b. growth and developmental status. c. genetic and familial health problems. d. ethnic and cultural backgrounds. ANS: C
A pedigree diagram, or genogram, shows consanguinity of health problems. Sexual orientation and history are noted in the review of systems (ROS). Growth and development are plotted on a percentile chart. Ethnic and cultural backgrounds are noted in the family history. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. When taking a history, you should: a. ask the patient to give you any information they can recall about their health. b. start the interview with the patient’s family history. c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. ANS: C
To give structure to the present problem or chief complaint, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and electric structure do not provide structure to the history. Gathering the patient’s family history is only the first step. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 11 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. When questioning the patient regarding his or her sexual history, which question should be
asked initially? a. “Do you have any particular sexual likes or dislikes?” b. “Do you have any worries or concerns regarding your sex life?” c. “How often do you have intercourse and with whom?” d. “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient’s feelings about the issue. “Do you have any particular sexual likes or dislikes?” is not a question that should be asked in an interview regarding sexual history. “How often do you have intercourse and with whom?” and “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” are not questions that should be asked initially in an interview regarding the patient’s sexual history. DIF: Cognitive Level: Applying (Application) REF: p. 10 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. A guideline for history taking is for caregivers to: a. ask direct questions before open-ended questions so that data move from simple to
complex. b. ask for a complete history at once so that data are not forgotten between meetings. c. make notes sparingly so that the patient can be observed during the history taking. d. write detailed information as stated by patients so that their priorities are reflected. ANS: C
During the interview, you should maintain eye contact with the patient, observing body language and proceeding from open-ended to direct questions. Asking direct questions first may upset the patient. During the interview you should gather as much information as you need for the current reason the patient is seeking health care. It is important to focus on the patient. Brief notes can be charted, but you should maintain eye contact with the patient, observing body language and proceeding from open-ended to direct questions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Mr. D complains of a headache. During the history, he mentions his use of alcohol and illicit
drugs. This information would most likely belong in the: a. chief complaint. b. past medical history. c. personal and social history. d. review of systems. ANS: C
Habits are included within the personal and social history. The chief complaint is the reason the patient is seeking health care. The past medical history is made up of the previous medical conditions that the patient has had. The review of systems is an overview of problems with other body systems. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 12 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. Direct questioning about domestic violence in the home should be: a. a routine component of history taking with female patients. b. avoided for fear of offending the woman’s partner. c. conducted only in cases in which there is a history of abuse. d. used only when the patient is obviously being victimized. ANS: A
The presence of domestic violence should be routinely queried, and the questioning should be direct for all female patients. Direct questioning about domestic violence in the home should not be avoided for fear of offending the woman’s partner, should be part of a routine examination, and should not be used only when the patient is obviously being victimized. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 9 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Mrs. G reports an increase in her alcohol intake over the past 5 years. To screen her for
problem drinking, you would use the: a. CAGE questionnaire. b. PACES assessment. c. Miller Analogies Test. d. Glasgow Coma Scale. ANS: A
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol. PACES is used to screen adolescents for important issues in their life. The Miller Analogies Test is used is used to test cognitive functioning. The Glasgow Coma Scale is a neurology assessment. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 8 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. A tool used to screen adolescents for alcoholism is the: a. CAGE. b. CRAFFT. c. PACES. d. HITS. ANS: B
The CRAFFT tool is used to screen for alcoholism in adolescents. The CAGE test is used to screen for alcoholism in adults. PACES is used to screen adolescents for important issues in their life. HITS is the screen for domestic violence. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 8 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s
lap. She turns away from you when you greet her. Initially, your best response is to: a. leave the child sitting in the father’s lap while you talk to the father. b. ask the child to be seated on the examination table so that you can talk to her father. c. explain to the child that you will not hurt her and that she will have to trust you. d. ask the father to persuade the child to cooperate with you. ANS: A
Interaction with children must be modified according to the child’s age and in a manner that promotes trust. DIF: Cognitive Level: Applying (Application) REF: p. 14 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
38. Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems
unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health? a. Attachment to parents b. High self-esteem c. Low peer support needs d. Propensity for risk taking ANS: D
Adolescents tend to experiment with risky behaviors that can lead to a high incidence of morbidity and mortality. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 16 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Pain is difficult to assess in older adults because: a. drugs act more rapidly with age. b. their language skills decline. c. they tend to exaggerate symptoms. d. sharp pain may be felt as a dull ache. ANS: D
Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner than those of other age groups. Older adults tend to think pain in aging is normal. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 19 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health
promotion. A survey of mobility and activities of daily living (ADLs) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, ADLs, and instrumental activities of daily living (IADLs). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 19 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Constitutional symptoms in the ROS refer to: a. height, weight, and body mass index. b. fever, chills, fatigue, and malaise. c. hearing loss, tinnitus, and diplopia. d. rashes, skin turgor, and temperature. ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 13 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of
acute sinusitis. The type of history that is warranted is a(n) _________ history. a. complete b. inventory c. problem or focused d. interim ANS: C
If the patient is well known, or if you have been seeing the patient for the same problem over time, a focused history is appropriate. A complete history is only obtained during initial visits or during a complete history and physical examination (H&P). An inventory is related to but does not replace the complete history. It touches on the major points without going into detail. This is useful when the entire history taking will be completed in more than one session. An interim history is only obtained during a return of the patient after several months of absence. DIF: Cognitive Level: Applying (Application) REF: p. 20 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following are connection types of communication? (Select all that apply.) a. Poor self image b. Good eye contact c. Avoiding being judgmental d. Ensuring good lighting e. Respecting silence f. Ensure confidentiality ANS: B, C, E
Poor self-image, ensuring good lighting, and ensuring confidentiality are not connection types of communications; good eye contact, avoiding being judgmental, and respecting silence are connections to communication. DIF: Cognitive Level: Applying (Application) REF: p. 3 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 02: Cultural Competency Test Bank—Nursing MULTIPLE CHOICE 1. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical
examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator? a. Race b. Rite c. Ritual d. Norm ANS: A
Race is a physical, not a cultural, differentiator. Rite is a prescribed, formal, customary observance. Ritual is a stereotypic behavior regulating religious, social, and professional behaviors. A norm is a prescribed standard of allowable behavior within a group. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 22 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which statement is true regarding the relationship of physical characteristics and culture? a. Physical characteristics should be used to identify members of cultural groups. b. There is a difference between distinguishing cultural characteristics and
distinguishing physical characteristics. c. To be a member of a specific culture, an individual must have certain identifiable physical characteristics. d. Gender and race are the two essential physical characteristics used to identify cultural groups. ANS: B
Physical characteristics are not used to identify cultural groups; there is a difference between the two, and they are considered separately. Physical characteristics should not be used to identify members of cultural groups. To be a member of a specific culture, an individual does not need to have certain identifiable physical characteristics. You should not confuse physical characteristics with cultural characteristics. Gender and race are physical characteristics, not cultural characteristics, and are not used to identify cultural groups. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 22 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. An image of any group that rejects its potential for originality or individuality is known as
a(n): a. acculturation. b. norm. c. stereotype. d. ethnos. ANS: C
A fixed image of any group that rejects its potential for originality or individuality is the definition of stereotype. Acculturation is the process of adopting another culture’s behaviors. A norm is a standard of allowable behavior within a group. Ethnos implies the same race or nationality. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 22 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L’s son
tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? a. “With your father’s permission, we will examine the stone and request that it be returned to him.” b. “The stone must be sent to the lab for examination and therefore cannot be kept.” c. “We cannot let him keep his stone because it violates our infection control policy.” d. “We don’t know yet if your father has another kidney stone, so we must analyze this one.” ANS: A
We should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient’s cultural background. “With your father’s permission, we will examine the stone and request that it be returned to him” is the most appropriate response. “The stone must be sent to the lab for examination and therefore cannot be kept” and “We don’t know yet if your father has another kidney stone, so we must analyze this one” do not support the patient’s request. “We cannot let him keep his stone because it violates our infection control policy” does not provide a reason that it would violate an infection control policy. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The motivation of the health care professional to “want to” engage in the process of becoming
culturally competent, not “have to,” is called: a. cultural knowledge. b. cultural awareness c. cultural desire d. cultural skill. ANS: C
Cultural encounters are the continuous process of interacting with patients from culturally diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a cultural group and to develop cultural desire, cultural awareness, cultural skill, and cultural knowledge. Cultural awareness is deliberate self-examination and in-depth exploration of one's biases, stereotypes, prejudices, assumptions and “-isms” that one holds about individuals and groups who are different from them. Cultural knowledge is the process of seeking and obtaining a sound educational base about culturally and ethnically diverse groups. Cultural skill is the ability to collect culturally relevant data regarding the patient's presenting problem, as well as accurately performing a culturally based physical assessment in a culturally sensitive manner. Cultural desire is the motivation of the health care professional to want to engage in the process of becoming culturally competent, not have to.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 22 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with
the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to: a. forego the examination for fear of violating cultural norms. b. ask a colleague from the same geographic area if this examination is acceptable. c. inform the patient of the reason for the examination and ask if it is acceptable to him. d. refer the patient to a provider more knowledgeable about cultural differences. ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. Not completing the examination could cause the patient further harm. Asking a colleague from the same geographic area if this examination is acceptable may not be appropriate. Referring the patient to a provider more knowledgeable about cultural differences at this point is unnecessary. DIF: Cognitive Level: Applying (Application) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Which statement is true regarding the impoverished? a. The morbidity and mortality rates of the impoverished are similar to those of the
middle class. b. The morbidity and mortality rates of the impoverished are higher than those of the
middle class. c. The morbidity and mortality rates of the impoverished are lower than those of the
middle class. d. No reliable statistics exist regarding the relationship of poverty to morbidity and
mortality. ANS: B
The morbidity and mortality rates of the impoverished are higher than those of the middle class. The poorly educated and those in poverty die at higher rates than those who are advantaged; the same is true for morbidity. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 23 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The root of social, political, and economic tragedy is often: a. acceptance of acculturation. b. cultural attitudes. c. cultural translation. d. resistance to change. ANS: D
To protect and maintain our sociopolitical culture, we tend to resist change. This resistance can have negative sociopolitical and economic consequences. Acceptance of acculturation is the process whereby an individual accommodates to the traits of another culture. Cultural attitudes are often vague; however, they do not cause social, political, or economic tragedy. Cultural translation describes a cultural barrier that exists without a language barrier.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic.
Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? a. “How often do you have medical examinations?” b. “What is your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” ANS: D
“Why do you think you are having these symptoms?” is an open-ended question that avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. The other questions do not explore the patient’s cultural beliefs about health problems. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The definition of ill or sick is based on a: a. stereotype. b. cultural behavior. c. belief system. d. cultural attitude. ANS: C
The definition of ill or sick is based on the individual’s belief system and is determined in large part by his or her enculturation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Mr. Jones is a 45-year-old patient who presents to the office. A person’s definition of illness is
likely to be most influenced by: a. race. b. socioeconomic class. c. enculturation. d. age group. ANS: C
The definition of illness is determined in large part by the individual’s enculturation (the process whereby an individual assumes the traits and behaviors of a given culture). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. As the health care provider, you are informing a patient that he or she has a terminal illness.
This discussion is most likely to be discouraged in which cultural group? a. Navajo Native Americans b. Dominant Americans c. First-generation African descendants
d. First-generation European descendants ANS: A
The Navajo culture believes that thought and language have the power to shape reality; the desire to avoid discussing negative information is particularly strong in this culture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids
eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask? a. “We will be able to communicate better if you look at me.” b. “It’s hard for me to gather useful information because your answers are so short.” c. “Are you uncomfortable talking with me?” d. “Does your religion make it hard for you to answer my questions?” ANS: C
It is all right to ask if the patient is uncomfortable with any aspect of your person and to talk about it; the other choices are less respectful. DIF: Cognitive Level: Applying (Application) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. As you explain your patient’s condition to her husband, you notice that he is leaning toward
you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to: a. tell him that you understand his need to be alone. b. ask whether he has any questions. c. ask whether he would prefer to speak to the clinician. d. tell him that it is all right to be angry. ANS: B
The English worry about being overheard and tend to speak in modulated voices so, when they lean in toward you, they are probably poised to ask a question. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native
Americans, Asians, and Arabs is Western medicine’s attempts to: a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. restore balance in an individual’s life. ANS: B
A more scientific approach to health care problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more holistic approach. Using a holistic approach, establishing harmony between a person and the entire cosmos, and restoring balance in an individual’s life would not be troublesome to many Hispanics, Native Americans, Asians, and Arabs. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. In a naturalistic or holistic approach to health, an example of a hot symptom would be: a. diarrhea. b. an earache. c. a headache. d. a nasal cold. ANS: A
A hot symptom in cultures with a holistic approach is diarrhea. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. An example of a cold condition would be: a. a fever. b. a rash. c. tuberculosis. d. an ulcer. ANS: C
A cold condition in cultures with a holistic approach is tuberculosis. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. An example of a cold food is: a. cod. b. eggs. c. oil. d. onions. ANS: A
Cod is a cold food. Eggs, oil, and onions are hot foods. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Penicillin is considered a: a. cold herb. b. cold medicine. c. hot medicine. d. lukewarm oil.
ANS: C
Penicillin is an example of a hot medicine. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 26 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is
likely to be most problematic for the hypertensive patient of which group? a. Native Americans b. Hispanics c. Chinese d. Italians ANS: C
The Chinese are most likely to use MSG and soy sauce in their diet. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 28 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Which maternal factor is most predictive of whether an infant will receive inoculations? a. Mother has family support b. Mother is divorced c. Mother received prenatal care d. Mother uses drugs ANS: C
Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 28 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which adolescents are most likely to engage in risky behaviors? a. Those who spend large amounts of time watching television and listening to heavy
metal music b. Those who represent minority races and/or cultural groups c. Females who represent minority groups d. Those who are of lower socioeconomic status because of limited parental education ANS: A
Adolescents who spend a lot of time watching television and listening to heavy metal music are more likely than any other group to engage in risky behaviors regardless of race, gender, or parents’ education. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 28 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Adolescents most likely to smoke, abuse substances, perform poorly in school, and be
depressed are those who are: a. from dual-income families. b. from families that emphasize strong religious beliefs.
c. from deprived socioeconomic groups. d. unsupervised after school. ANS: D
Adolescents who are unsupervised after school are more likely to smoke, abuse substances, perform poorly in school, and be depressed than adolescents in any other situation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 28 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Knowledge of the culture(s) represented by the patient should be used to: a. form a sense of the patient. b. help make the interview questions more pertinent. c. form stereotypical categories. d. draw conclusions regarding individual patient needs. ANS: B
The purpose of understanding the patient’s culture(s) is to help the provider construct pertinent questions and avoid stereotyping. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 27 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. The attitudes of the health care professional: a. are largely irrelevant to the success of relationships with the patient. b. do not influence patient behavior. c. are difficult for the patient to sense. d. are culturally derived. ANS: D
The attitudes of the health care provider are foundationally derived from his or her own culture; understanding this is relevant to the success of patient relationships. Attitudes of the health care professional are easily detected by others, and they influence patient behavior; they are not irrelevant to the success of relationships with the patient; they do influence patient behavior; and they are not difficult for the patient to sense. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 29 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following variables can intrude on successful communication? (Select all that
apply.) a. Social class b. Gender c. Stereotype d. Phenotype e. Age ANS: A, B, E
Social class, age, and gender are variables that characterize everyone; they can intrude on successful communication if there is no effort for mutual knowledge and understanding.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 24 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation SHORT ANSWER 1. In terms of cultural communication differences, Americans are more likely to _____________
than are other groups of patients. ANS:
come quickly to the point In the United States, individuals are very direct in conversation and come to the point quickly. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 29 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 03: Examination Techniques and Equipment Test Bank—Nursing MULTIPLE CHOICE 1. Guidelines for Standard Precautions indicate that mask and eye protection or a face mask
should be used while performing: a. tube feedings. b. patient bathing. c. wet to dry dressing changes. d. trachea care and suctioning. ANS: D
Use of masks and eye protection or a face mask is indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. During tube feedings, patient bathing, and wet to dry dressing changes, there is no splashing of body fluids. DIF: Cognitive Level: Applying (Application) REF: p. 30 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Standard Precautions apply: a. only to patients with bloodborne infections. b. only to patients with infected, draining wounds. c. only to patients believed to have an infectious disease. d. to all patients receiving care in hospitals. ANS: D
Standard Precautions were developed with the intent of application to the care of all hospitalized patients; however, the standard has merit to be applied to all cases of patient care, regardless of the environment in which care is delivered. Standard Precautions apply to all patients, not just those with bloodborne infections, infected, draining wounds, or those believed to have an infectious disease. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 31 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. According to the guidelines for Standard Precautions, the caregiver’s hands should be washed: a. only after touching body fluids with ungloved hands and between patient contacts. b. only after touching blood products with ungloved hands and after caring for
infectious patients. c. only after working with patients who are thought to be infectious. d. after touching any body fluids or contaminated items, regardless of whether gloves
are worn. ANS: D
Hand washing is to be done after removal of gloves, between patient contacts, and after touching body fluids, regardless of whether gloves are used. The nurse should never touch body fluids or blood products with ungloved hands. The nurse should use hand hygiene regardless of a patient’s possible infection.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 31 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Which patient is at the highest risk for developing latex allergy? a. The new patient who has no chronic illness and has never been hospitalized b. The patient who has had multiple procedures or surgeries c. The patient who is a vegetarian d. The patient who is allergic to contrast dye ANS: B
The patient who has had multiple procedures or surgeries has a higher rate of exposure to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 30 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. One recommendation to prevent latex allergy is to: a. wear latex gloves frequently to reduce sensitivity. b. use oil-based creams or lotions before donning gloves. c. wash hands with mild soap after removing gloves and then dry thoroughly. d. use well-powdered gloves with increased protein content. ANS: C
The recommendations are to use nonlatex gloves for situations not likely to involve infectious materials, not to use oil-based creams or lotions, wash hands with mild soap and dry thoroughly after removing gloves, or use powder-free latex gloves with reduced protein content. DIF: Cognitive Level: Applying (Application) REF: p. 30 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Walder is a 56-year-old man who has been complaining of chest palpitations. Which
position is useful for auscultating heart sounds? a. Prone b. Dorsal recumbent c. Left lateral recumbent d. Right Sims ANS: C
The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for auscultating low-pitched sounds, such as the third and fourth heart sounds. If the patient is in the prone, dorsal recumbent, or right Sims position, you will not be able to auscultate heart sounds. The dorsal recumbent position is for examination of the rectum and genitalia. The Sims position is the position for examination of the rectum. DIF: Cognitive Level: Applying (Application) REF: p. 32 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Which technique is used during both the history taking and the physical examination process? a. Auscultation
b. Inspection c. Palpation d. Percussion ANS: B
Inspection is the technique that is used while gathering and validating data during both the history taking and the actual hands-on physical examination. Auscultation, palpation, and percussion are not used during the history taking and physical examination processes. It is not possible to listen to the patient talking and use the stethoscope at the same time. The focus is on the patient’s response to your touch and what you are feeling; it is not possible to perform palpation and listen to the patient talking at the same time. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 32 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Ms. Jones is a 31-year-old female patient who presents for a routine physical examination.
Which examination technique will be used first? a. Light palpation b. Deep palpation c. Percussion d. Inspection ANS: D
Inspection, the process of systematic observation, is the first technique used in an examination. Light palpation is used after inspection. The order for examination is usually inspection, palpation, percussion, and then auscultation. Deep palpation is used after inspection. Percussion is used after inspection and palpation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 32 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. The use of secondary, tangential lighting is most helpful in the detection of: a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. ANS: D
Tangential lighting is used to cast shadows to observe contours and variations in body surfaces best. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 33 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse,
that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? a. Drape the patient and observe the rectal area. b. Tell the patient that his doctor will be notified of his problem. c. Tell the patient that you will ask the male nurse on the next shift to check on the problem. d. Give the patient an ice pack to apply to the area.
ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The complaint warrants validation before referral or delegation. Before you call the physician, you need to assess the patient. The assessment should not wait for another shift. Before treatment, it is important to assess the complaint. DIF: Cognitive Level: Applying (Application) REF: p. 32 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Mrs. Smalls is a 42-year-old woman who has presented to the office for a head to toe
examination as part of her preventive health care assessment. The room has adequate lighting, and you have access to both sides of the examining table. What position should you assume while conducting this examination? a. Behind the patient b. Either side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient ANS: B
Although examiners are conventionally taught to approach an examination from the patient’s right side, it is not always practical; therefore the most appropriate response is that the examiner should develop skills necessary to approach either side of the patient. If you approach the patient from behind, you will not have access to the anterior areas for assessment. If you are seated, you will not be able to assess all areas of the patient. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 33 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is
best for palpating vibration? a. Dorsal surface b. Finger pads c. Fingertips d. Ulnar surface ANS: D
The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The finger pads and fingertips are best for palpating pulses. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 33 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The dorsal surface of the hand is most often used for the assessment of: a. crepitus. b. temperature. c. texture. d. vibration. ANS: B
The dorsal surface, or back of the hand, is best for assessing warmth, or temperature. The palmar surface, rather than the dorsal surface, is best for assessing crepitus. The palmar surface, rather than the dorsal surface, is best for assessing texture. The ulnar surfaces of the hand and fingers, rather than the dorsal surface, are best for assessing vibration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 33 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal
pain. You have completed the inspection of the abdomen. What is your next step in the assessment process? a. Light palpation b. Deep palpation c. Percussion d. Auscultation ANS: D
Auscultation precedes palpation or percussion of the abdomen because these techniques can stimulate peristalsis, which may alter correct assessment of the abdominal sounds. Light palpation, deep palpation, and percussion should not be completed until auscultation is completed. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 35 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. The degree of percussion tone is determined by the density of the medium through which the
sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder is the percussion tone. b. The less dense the medium, the louder is the percussion tone. c. The more hollow the area percussed, the quieter is the percussion tone. d. Percussion over muscle areas produces the loudest percussion tones. ANS: B
Percussion sounds vary according to the tissue being percussed. Less dense tissue (such as that over normal lungs) produces a loud tone, whereas more dense tissue (such as a muscle) produces a softer tone. The more dense the medium, the softer is the percussion tone. The more hollow the area, the louder is the percussion tone. Percussion tones over muscle are soft and flat. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Expected normal percussion tones include: a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. ANS: C
A normal lung produces resonance percussion tones, whereas an empty stomach is expected to produce tympany. Dullness indicates atelectasis of the lung. Hyperresonance over the lungs indicates emphysema. Flatness occurs over muscle. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. During percussion, a dull tone is expected to be heard over: a. healthy lung tissue. b. emphysemic lungs. c. the liver. d. most of the abdomen. ANS: C
Dull tones are expected over denser areas such as the liver. Healthy lung tissue is resonant. Emphysemic lungs are hyperresonant. Tympany is heard over most of the abdomen. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. When using mediate or indirect percussion, which technique is appropriate? a. Place the palmar surface of the nondominant hand on the body surface, with the
fingers held together. b. Place the palmar surface of the nondominant hand on the body surface, with the
fingers slightly spread apart. c. Place the ulnar surface of the nondominant hand on the body surface, with the
fingers together. d. Place the ulnar surface of the nondominant hand on the body surface, with the
fingers slightly spread apart. ANS: B
The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. A helpful tip to improve elicitation of correct tones is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint firmly against the body surface. This lifting of the fingertip avoids dampening of the vibratory sounds. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. During percussion, the downward snap of the striking fingers should originate from the: a. shoulder. b. forearm. c. wrist. d. interphalangeal joint. ANS: C
The downward snap of the striking fingers should originate from the wrist. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
20. Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or
kidneys? a. Finger percussion b. Palmar percussion c. Fist percussion d. Forearm percussion ANS: C
Fist percussion is a direct percussion technique used to elicit tenderness over organs such as the liver, gallbladder, or kidneys. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 34 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. During auscultation, you can limit your perceptual field best by: a. asking patients to describe their symptoms. b. closing your eyes. c. performing auscultation before percussion. d. using an aneroid manometer. ANS: B
By closing your eyes, your sense of hearing becomes more acute, and it increases your ability to isolate sounds. Asking patients to describe their symptoms does not assist in the technique of auscultation. The only time that auscultation occurs before percussion is in examination of the abdomen. Using an aneroid manometer does not assist in the technique of auscultation. During auscultation, the only equipment needed is the stethoscope. DIF: Cognitive Level: Applying (Application) REF: p. 35 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty
distinguishing between respirations and heartbeats. Which technique can you use to facilitate your assessment? a. Anticipate the next sounds. b. Isolate each cycle segment. c. Listen to all sounds together. d. Move the stethoscope clockwise. ANS: B
If you are hearing everything at once, it is more difficult to distinguish different sounds. Try isolating each segment and listen to that segment intently; then move on to another segment. For example, listen only to breath sounds, then only to inspiratory breath sounds, and then only to expiratory breath sounds. Anticipating the next sounds will not facilitate the assessment. Listening to all sounds together will not facilitate the assessment. One of the most difficult achievements in auscultation is learning to isolate sounds. Moving the stethoscope clockwise will not facilitate the assessment. DIF: Cognitive Level: Applying (Application) REF: p. 35 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Auscultation should be carried out last, except when examining the: a. neck area.
b. heart. c. lungs. d. abdomen. ANS: D
Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 35 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Tympanic thermometers measure body temperature when a probe is placed: a. anterior to the ear. b. posterior to the ear. c. under the ear. d. in the auditory canal. ANS: D
Tympanic thermometer probes are placed at the external opening of the auditory canal. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 38 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. A scale used to assess patients’ weight should be calibrated: a. only by the manufacturer. b. by a qualified technician at regularly scheduled intervals. c. each time it is used. d. when necessary, with the patient standing on the scale. ANS: C
Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. The manufacturer does not calibrate the scale after it is sold. A qualified technician does not calibrate the scale at regularly scheduled intervals. Scales cannot be calibrated with the patient standing on the scale. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 37 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. The height-measuring attachment of the standing platform scale should be pulled up: a. before the patient steps on the scale. b. before the scale is balanced. c. after the patient steps on the scale. d. only after weight has been assessed. ANS: A
To ensure patient safety, the arm of the height-measuring attachment should be pulled up before the patient steps on the scale, after the scale is balanced, and before weight is assessed. DIF: Cognitive Level: Applying (Application) REF: p. 37 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
27. The infant should be placed in which position to have his or her height or length measured? a. Vertically, with the examiner’s hands under the infant’s axillae b. Supine on a measuring board c. Prone on a measuring board d. In the lateral position, with the toes against a measuring board ANS: B
The infant should be placed supine on a measuring board to measure height or length. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 37 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell
endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece. c. Assessment findings are more accurate. d. Most sounds are occluded. ANS: B
Applying firm pressure to the bell endpiece causes the skin to act as a diaphragm, obliterating the low-pitched sounds. DIF: Cognitive Level: Applying (Application) REF: p. 39 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. A rubber or plastic ring should be around the bell endpiece of a stethoscope to: a. prevent the transmission of static electricity. b. prevent cold metal from touching the patient. c. prevent the sharp edge of the stethoscope from damaging the patient’s skin. d. ensure secure contact with the body surface. ANS: D
The ring around the bell portion of the stethoscope secures contact with body surfaces when placed lightly on the skin. DIF: Cognitive Level: Applying (Application) REF: p. 39 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of
stethoscope? a. Acoustic b. Electronic c. Ultrasonic d. Magnetic ANS: C
Only the ultrasonic stethoscope, the Doppler, can detect blood flow rather than amplify sounds, which is needed in assessing weak pulses, fatal heart activity, and vessel patency. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 39 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
31. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector
clockwise and then counterclockwise to compensate for: a. amblyopia. b. astigmatism. c. myopia. d. strabismus. ANS: C
Rotating the lens selector compensates for myopia (nearsightedness) or hyperopia (farsightedness) in the examiner and patient. DIF: Cognitive Level: Applying (Application) REF: p. 42 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. A patient in the emergency department has a concussion. You suspect the patient may also
have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient? a. Grid b. Red-free filter c. Slit lamp d. Small aperture ANS: B
The red-free filter permits recognition of hemorrhages. The grid estimates the size of lesions, the slit lamp examines the anterior eye and assesses the elevation of lesions, and the small aperture is used with small pupils. DIF: Cognitive Level: Applying (Application) REF: p. 42 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Which type of speculum should be used to examine a patient’s tympanic membrane? a. The smallest speculum that will illuminate the ear b. The largest speculum that will fit comfortably in the ear c. The shortest speculum available d. Any speculum that will fit the otoscope head ANS: B
To visualize the tympanic membrane adequately, the largest speculum that can comfortably fit in the ear canal should be used. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 45 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. The pneumatic attachment for the otoscope is used to evaluate: a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. ANS: D
The pneumatic attachment on the otoscope produces a puff of air directed to the tympanic membrane, resulting in its movement. The pneumatic attachment for the otoscope is not used to evaluate ear canal patency, eardrum landmarks, or hearing acuity. Ear canal patency is assessed by visually inspecting the ear. Hearing acuity is assessed by the whisper test. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 45 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective
assessment of this complaint is achieved by using the: a. tuning fork. b. reflex hammer. c. otoscope with pneumatic attachment. d. tympanometer. ANS: D
This patient is describing eustachian tube dysfunction. The tympanometer measures compliance of the middle ear as air pressures are varied. It is an objective means of assessing the function of the ossicular chain, eustachian tube, and tympanic membrane. The tuning fork assesses vibration. The reflex hammer assesses tendon reflexes. The otoscope with pneumatic attachment assesses tympanic membrane movement. DIF: Cognitive Level: Applying (Application) REF: p. 45 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: a. buzzing or tingling sensations. b. buzzing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level. ANS: C
Normal speech has a range of 300 to 3000 Hz; therefore the 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 46 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. To perform a deep tendon reflex measurement, you should: a. briskly tap the tendon with the rubber end of the hammer. b. place the hammer firmly on the tendon for 3 to 5 seconds. c. tap the silver end of the hammer on the tendon. d. use the needle implement to determine sensory perception. ANS: A
Deep tendon reflexes are measured by quickly and firmly tapping either end of the rubber hammer on the stretched tendon and then observing muscle movement. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 46 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
38. A variant of the percussion hammer is the neurologic hammer, which is equipped with which
of the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell ANS: A
The neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews to reveal an attached sharp needle. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 46 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. When monitoring serial measures, such as head circumference or abdominal girth, which
procedure is best to ensure that the tape measure is placed in the same position each time? a. Record the anatomic location for tape placement in the patient’s chart. b. Mark the borders of the tape at several intervals on the skin with a pen. c. Demonstrate proper tape placement to all members of the health care team. d. Ask the same person to perform the measurement each time. ANS: B
The most effective procedure to ensure correct serial measurements is to mark the borders at several intervals so that with the next measurements, the tape is in the same location. Recording the anatomic location for tape placement in the patient’s chart or demonstrating proper tape placement does not ensure accuracy. The same person may not always be available. DIF: Cognitive Level: Applying (Application) REF: p. 47 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Transillumination functions on the principle that: a. air, fluid, and tissue transmit light differentially. b. black light causes certain substances to fluoresce. c. converging and diverging light brings structures into focus. d. tangential light casts shadows that illuminate contours. ANS: A
Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 47 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. When transillumination of a body cavity is performed, the use of which of the following could
be harmful to the patient? a. Penlight b. Flashlight c. Halogen bulb d. Otoscope light ANS: C
A halogen bulb can burn the skin. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 47 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. The Pederson speculum has blades that: a. are smaller than a plastic one. b. have an auto lock feature c. are narrower and flatter. d. only the bottom blade moves. ANS: C
The Pederson speculum has blades that are as long as those of the Graves speculum but are narrower and flatter. It is used for women with small vaginal openings. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 47 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following are causes of hyperreflexia? (Select all that apply.) a. Cold stirrups b. Standard scale c. Insertion of a speculum d. Fever e. Pressure during bimanual exam ANS: A, C, E
Hyperreflexia is often caused by a cold, hard, examination table, cold stirrups, insertion or manipulation of a speculum, or pressure during bimanual or rectal examinations. DIF: Cognitive Level: Applying (Application) REF: p. 37 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. The Snellen E vision acuity chart would most likely be used for __________. ANS:
preschool children The E chart is used for children 3 to 5 years of age or others who do not know the alphabet. The examinee is asked which way the E points. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 44 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The stethoscope’s diaphragm is most useful for the assessment of __________ sounds. ANS:
high-pitched
The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 40 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. For a woman with a small vaginal opening, the examiner should use a __________ speculum. ANS:
Pederson The Pederson speculum has blades that are as long as those of the Graves speculum but are narrower and flatter and therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. DIF: Cognitive Level: Applying (Application) REF: p. 47 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 04: Vital Signs and Pain Assessment Test Bank—Nursing MULTIPLE CHOICE 1. The pyrexia response is triggered by the production and release of: a. prostaglandins. b. endogenous pyrogens. c. hypothalamic enzymes. d. thyroid hormones. ANS: A
When microorganisms invade the body, pyrogens are released and travel to the hypothalamus. The pyrexia response is then triggered by the production and release of prostaglandins. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 50 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. During respiration, the internal intercostals: a. increase the force of muscular contraction. b. decrease the lateral diameter during expiration. c. decrease the intrathoracic space. d. increase elastic recoil during expiration. ANS: B
The diaphragm is the dominant muscle during respiration. It contracts and pushes downward during inspiration to increase the intrathoracic space. The external intercostal muscles increase the AP diameter during inspiration and the internal intercostals decrease the lateral diameter during expiration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 50 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The fifth vital sign is: a. pain. b. orientation. c. waist-to-hip ratio. d. body mass index (BMI). ANS: A
Pain, the universal distress signal, is now recognized as the fifth vital sign. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 50 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The Joint Commission (TJC) requires that: a. pain be assessed on all discharges. b. repeated assessment of pain be limited to those patients who complain of pain. c. repeated intensity documentation be made of the course of pain relief for all
patients. d. pain be assessed on surgical patients.
ANS: C
TJC requires pain assessment on all admissions, repeated assessments for pain regardless of the initial complaint or surgical experience, and repeated intensity documentation of the course of pain relief for all patients. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 50 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The perception of pain: a. is the same across cultures. b. can be easily assessed in neonates. c. is predictable with the same circumstances. d. is affected by emotions and quality of sleep. ANS: D
The perception of pain is variable and is affected by emotions, cultural background, sleep deprivation, previous pain experience, and age. Perception of pain is different among different cultures. Neonates do feel pain, but perception of pain cannot be assessed in neonates. Each circumstance will provide different pain perception. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 51 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The nurse assesses the blood pressure to be 140/62 mm Hg and records 78 as the: a. pulse pressure. b. pulse deficit. c. afterload. d. preload. ANS: A
Systolic pressure – diastolic pressure = pulse pressure. Pulse deficit occurs when the number of pulse beats counted at the radial pulse is less than those counted at the same time at the heart. Afterload and preload are not measured according to blood pressures. DIF: Cognitive Level: Applying (Application) REF: p. 50 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. Hypertension in the adult is generally defined as pressure in excess of: a. 120 mm Hg plus the patient’s age. b. 140 mm Hg. c. 160 mm Hg. d. 200 mm Hg. ANS: B
Optimal blood pressure is below 120/80 mm Hg. According to JNC7, hypertension continues to be defined as 140/90 mm Hg and higher. Prehypertension is the range between optimal and hypertension. The equation that systolic blood pressure should be less than 120 mm Hg plus the patient’s age is no longer the acceptable definition. DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 54
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Reduction of Risk Potential
8. A blood pressure cuff bladder should be long enough to: a. cover 20% to 25% of the arm circumference. b. cover 45% to 50% of the arm circumference. c. cover 75% to 80% of the arm circumference. d. completely encircle the arm. ANS: C
The length of the cuff bladder should be twice its width, or about 75% to 80% of the limb circumference. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. If a sufficiently large cuff is unavailable to fit an obese arm, which technique may be used to
assess blood pressure? a. Wrap a standard cuff around the deltoid area and place the stethoscope over the radial artery. b. Wrap a standard cuff around the forearm and place the stethoscope over the radial artery. c. Wrap a standard cuff around the thigh and place the stethoscope on the dorsalis pedis. d. Wrap a pediatric cuff around the ankle and place the stethoscope on the popliteal artery. ANS: B
A technique to use when assessing the blood pressure of an obese person and you only have a standard adult cuff is to wrap the cuff around the smaller forearm, and place the stethoscope over the radial artery. This substitution should comply with the cuff standard of one third to one half of the circumference of the limb. The cuff should be wrapped around the forearm, not the deltoid or thigh areas. A pediatric cuff will not fit the ankle. DIF: Cognitive Level: Applying (Application) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Postural hypotension is defined as a ___________________ when the patient stands
compared with sitting or supine readings. a. systolic pressure drop of more than 15 mm Hg with a pulse rate increase b. pulse rate decrease with a systolic pressure increase of at least 15 mm Hg c. diastolic pressure increase of more than 5 mm Hg and no pulse rate changes d. pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg ANS: A
Postural hypotension (orthostatic hypotension) represents a significant decrease in systolic pressure greater than 15 mm Hg, an accompanied drop in diastolic pressure, and a rise in pulse rate whenever the position changes from sitting to standing. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 55 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. The most frequent cause of serious hypertension in children is:
a. b. c. d.
heart disease. liver failure. renal disease. rheumatic fever.
ANS: C
If the systolic blood pressure is elevated and the diastolic blood pressure is not, anxiety may be responsible. Blood pressure in children varies by gender and height at any age. Hypertension in children is becoming more common because of the increased prevalence of overweight children. Usually, hypertension is caused by kidney disease, renal arterial disease, coarctation of the aorta, and pheochromocytoma, not heart disease, liver failure, or rheumatic fever. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 58 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 12. Underestimation of blood pressure will occur if the cuff’s width covers: a. less than half of the upper arm. b. less than 5 inches of the lower arm. c. more than two thirds of the upper arm. d. more than 4 inches of the lower arm. ANS: C
Cuffs that are too wide will underestimate blood pressure, which would occur with a cuff that covers more than two thirds of the upper arm. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis,
for which she is given antiinflammatory medication. To assess her right knee pain, you should ask her if: a. the current pain is similar to previous pain. b. the left knee hurts as well. c. she took pain medication last night. d. the pain gets better when she sits. ANS: C
It is most appropriate to ask a present tense evaluation question, such as whether the patient took her pain medication; the question should be simply worded, without the addition of multiple factors to consider. You should refrain from asking older patients to compare past with present symptoms because recollection may be uncertain and recollection of past pain is sometimes not readily achieved. Systematic evaluation of the right knee should be completed before any additional symptoms are evaluated. Knowing that the pain gets better when she sits does not help assess the right knee pain. DIF: Cognitive Level: Applying (Application) REF: p. 56 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Body language that leads you to suspect that a person is in pain is: a. talkative, verbose speech. b. fretful hand movements.
c. focused, fixed eye stares. d. marked salivation. ANS: B
The person in pain may suddenly become quiet, have an inability to keep the hands still, and have lackluster eyes, pallor, diaphoresis, pupil dilation, and dry mouth. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 56 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Ms. Green is an 85-year-old female patient with dementia who presents to the emergency
department with her daughter because of a change in function. Which pain assessment scale would be the best choice? a. Oucher Scale b. Checklist for Nonverbal Pain Indicators c. Wong/Baker Rating Scale d. CRIES Scale ANS: B
The Checklist for Nonverbal Pain Indicators is for nonverbal adults. The Oucher and Wong/Baker Rating Scales are pediatric scales. The CRIES Scale is for infants. DIF: Cognitive Level: Applying (Application) REF: p. 60 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following occurs with malignant hypertension? (Select all that apply.) a. Blurred vision b. Sleep disturbance c. Tachycardia d. Dyspnea e. Encephalopathy ANS: A, D, E
Signs of malignant hypertension include headache, blurred vision, dyspnea, and encephalopathy. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 62 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. In a syndrome in which regional pain extends beyond this specific peripheral nerve injury,
you would notice which of the following: (Select all that apply.) a. Allodynia b. Sleep disturbance c. Blood flow changes d. Numbness e. Edema ANS: A, C, D, E
Complex regional pain syndrome includes the following symptoms: burning shooting pain with aching character, exaggerated sensitivity to cold, allodynia, numbness, edema, blood flow changes, and temperature changes DIF: Cognitive Level: Analyzing (Analysis) REF: p. 62 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation SHORT ANSWER 1. A normal adult’s pulse pressure should range from _____ to _____ mm Hg. ANS:
30; 40 An adult’s pulse pressure should range from 30 to 40 mm Hg, and may even be as high as 50 mm Hg. Pulse pressure is the difference between the systolic and diastolic pressures. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. The difference in blood pressure readings between the right and the left arms is considered
normal up to ___ mm Hg. ANS:
10 Blood pressure readings between the left and right arm may vary by as much as 10 mm Hg and tend to be higher in the right arm. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 3. If only two blood pressure values are recorded, they are the _______________ sounds. ANS:
first systolic and second diastolic Phase 1 (systolic sound) and phase 5 (second diastolic sound) would be recorded if only two blood pressure values were used. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 54 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 4. You are completing an examination on a 4-year-old child. Pain scales that are reliable and
valid for children are the _____ Scales. ANS:
Wong/Baker Faces Rating and Oucher The Wong/Baker Faces Rating and Oucher Scales are examples of pain scales that are reliable and valid for use with children.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 59 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Pain is often referred to as the fifth vital sign because ____________________. ANS:
of its association with tissue damage DIF: Cognitive Level: Analyzing (Analysis) REF: p. 56 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 05: Mental Status Test Bank—Nursing MULTIPLE CHOICE 1. When is the mental status portion of the neurologic system examination performed? a. During the history-taking process b. During assessment of cranial nerves and deep tendon reflexes c. During the time when questions related to memory are asked d. Continually, throughout the entire interaction with a patient ANS: D
A mental status evaluation should be continually performed throughout the patient encounter. Assessing and validating clues to determine the individual’s ability to interact within the environment is a priority of the mental status evaluation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 64 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken
language. This indicates a lesion in the: a. temporal lobe. b. Broca area. c. frontal cortex. d. cerebellum. ANS: A
The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 64 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Mr. DeLaurentis is a 58-year-old man who presents to your office with slumped posture and a
lack of facial expression, which may indicate depression or: a. Parkinson disease. b. anxiety. c. loss of abstract reasoning. d. attention-deficit/hyperactivity disorder. ANS: A
A slumped posture and lack of facial expression may be clues to more than depression; they are also defining characteristics of Parkinson disease. DIF: Cognitive Level: Applying (Application) REF: p. 64 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The ability for abstract thinking normally develops during: a. infancy. b. early childhood. c. adolescence.
d. adulthood. ANS: C
Abstract thinking is an intellectual maturation that develops during adolescence. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 64-65 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The Mini-Mental State Examination (MMSE) may be used to: a. estimate cognitive changes quantitatively. b. estimate personality disorders qualitatively. c. diagnose neurologic disorders. d. determine the cause of memory loss. ANS: A
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to document cognitive changes serially. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 67 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Assessing orientation to person, place, and time helps determine: a. ability to understand analogies. b. abstract reasoning. c. attention span. d. state of consciousness. ANS: D
Orientation to person, place, and time are measures of states of consciousness and awareness. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 66 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing
which of the following? a. Level of consciousness b. Abstract reasoning c. Emotional stability d. Memory ANS: B
Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the patient’s ability to reason abstractly. Asking the patient to tell you the meaning of a proverb or metaphor does not assess level of consciousness, emotional stability, or memory. The MiniMental State Examination tests memory. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 69 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Impairment of arithmetic skills is often the result of: a. impaired execution of motor skills. b. impaired judgment.
c. perceptual distortions. d. depression. ANS: D
The patient with depression can display difficulty with simple arithmetic calculations. DIF: Cognitive Level: Applying (Application) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Peripheral neuropathy is most likely to be manifested by: a. impaired memory. b. impaired abstract reasoning. c. impaired writing ability. d. hallucinations. ANS: C
Uncoordinated writing or drawing may indicate peripheral neuropathy, dementia, parietal lobe damage, or a cerebellar lesion. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Recent memory may be tested by: a. asking the patient to name the past four presidents. b. asking the patient to listen to and repeat a series of numbers. c. showing the patient four items and asking him or her to list the items about 10
minutes later. d. asking the patient about verifiable information, such as his or her mother’s maiden name. ANS: C
Showing the patient four or five objects, saying you will ask about them in a few minutes, and then 10 minutes later asking the patient to list the objects is a technique to measure recent memory. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Loss of immediate and recent memory with retention of remote memory suggests: a. attention-deficit/hyperactivity disorder (ADHD). b. impaired judgment. c. stupor. d. dementia. ANS: D
Dementia is the loss of both immediate and recent memory while retaining remote memories. ADHD is associated with recent and remote memory impairment. Impaired judgment is a thought process dysfunction. Stupor is impaired consciousness. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. You ask the patient to follow a series of short commands to assess: a. judgment. b. attention span. c. arithmetic calculations. d. abstract reasoning. ANS: B
Asking the patient to follow a series of short commands will test attention span. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Which of these observations would be most significant when assessing the condition of a
patient who has judgment impairment? a. Repeated failure to complete work obligations b. Forgetting family members’ birth dates c. Going to church three times a week d. Planning for retirement in 20 years ANS: A
Inadequately dealing with business affairs indicates impaired judgment, whereas the other choices do not. DIF: Cognitive Level: Applying (Application) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the
assessment of: a. mood and feelings. b. attention span. c. thought process and content. d. abstract reasoning. ANS: C
Thought process and content are examined while observing the patient’s patterns of thinking, especially appropriateness of sequence, logic, coherence, and relevance to the topics discussed. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 71-72 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Which type of hallucination is most commonly associated with alcohol withdrawal? a. Olfactory b. Visual c. Auditory d. Tactile ANS: D
Tactile hallucinations are most commonly associated with alcohol withdrawal. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 72 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
16. Flight of ideas or loosening of associations is associated with: a. aphasia. b. dysphonia. c. multiple sclerosis. d. psychiatric disorders. ANS: D
Flight of ideas, loosening of associations, word salads, neologisms, clang associations, echolalia, and utterances of unusual sounds are all associated with psychiatric disorders. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 71 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Facial muscle or tongue weakness may result in: a. aphasia. b. impaired comprehension. c. neologisms. d. echolalia. ANS: A
Aphasia can result from facial muscle or tongue weakness or from neurologic damage to the speech and language regions of the brain. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 71 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. The Glasgow Coma Scale is used to: a. determine the cause of decreased consciousness. b. diagnose disorders that alter level of consciousness. c. quantify consciousness. d. predict response to stimulant medications. ANS: C
The Glasgow Coma Scale is used when a patient has an altered level of consciousness and is used to quantify consciousness. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 67 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. The Denver II is a tool used to determine: a. a child’s IQ. b. a child’s mood. c. whether a child is educable. d. whether a child is developing as expected. ANS: D
Denver II is a tool used to determine whether the child is developing fine and gross motor, language, personal, and social skills as expected according to the child’s age. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 73 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
20. When the Goodenough-Harris Drawing Test is administered to a child, the evaluator
principally observes the: a. presence and form of body parts. b. gender and race of the person drawn. c. approximate age and posture of the person drawn. d. length of time needed to draw a stick man. ANS: A
The presence and form of body parts provide a clue about the child’s development when following the scoring criteria of the Goodenough-Harris Drawing Test. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 73 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. An older adult is administered the Set Test and scores a 14. The nurse interprets this score as
indicative of: a. depression. b. cognitive impairment. c. delirium. d. dementia. ANS: D
Scores of less than 15 on this mental function test indicate dementia. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 74 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which condition is considered progressive rather than reversible? a. Delirium b. Dementia c. Depression d. Anxiety ANS: B
Dementia is considered progressive and irreversible. Delirium has the potential for reversal. Depression and anxiety are reversible. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 76 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. A clinical syndrome of failing memory and impairment of other intellectual functions, usually
related to obvious structural diseases of the brain, describes: a. delirium. b. dementia. c. depression. d. anxiety. ANS: B
Dementia results from a chronic progressive deterioration of the brain that results in failing memory and impairment of other intellectual functioning.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 76 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Mrs. Griffiths, a 28-year-old patient, presents to your office to discuss her
attention-deficit/hyperactivity disorder (ADHD). Which statement is true in regard to ADHD? a. It occurs before 7 years of age. b. It is usually related to mental retardation. c. It is usually related to dementia. d. It is manifested by prolonged periods of catatonic behavior. ANS: A
ADHD occurs before 7 years of age. ADHD is not related to mental retardation, dementia, or prolonged periods of catatonic behavior. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 77 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. An aversion to touch or being held, along with delayed or absent language development, is
characteristic of: a. attention-deficit/hyperactivity disorder. b. autism. c. dementia. d. mental retardation. ANS: B
Autistic disorder involves a combination of behavioral traits (lack of awareness of others, aversion to touch or being held, odd or repetitive behaviors, or preoccupation with parts of objects) and communication deficits (usually echolalia [parrot speech]). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 78 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is
apathetic and has disturbed thoughts and language patterns. The nurse recognizes this behavior pattern as consistent with a diagnosis of: a. depression. b. autistic disorder. c. mania. d. schizophrenia. ANS: D
Schizophrenia manifests as a psychotic disorder of early adult onset, with disturbances in language and speech, emotions and social withdrawal, and apathy. Depression and mania do not have the language or speech component. Autistic disorders are not psychotic disorders, and they usually begin before 3 years of age. DIF: Cognitive Level: Applying (Application) REF: p. 77 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. The patient who is delirious usually maintains orientation to: a. time. b. place.
c. person. d. circumstance. ANS: C
The person with delirium is unable to orient to time, place, or circumstance, but remains oriented to person. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 76 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. While interviewing a patient, you ask him to explain the “Lion and the Mouse” to assess: a. reading comprehension. b. attention span. c. mood and feeling. d. reasoning skills. ANS: D
Having the patient explain fables or metaphors determines abstract reasoning skills. DIF: Cognitive Level: Applying (Application) REF: p. 69 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. The Mini-Mental State Examination (MMSE) should be administered for the patient who: a. gets lost in her neighborhood. b. sleeps an excessive amount of time. c. has repetitive ritualistic behaviors. d. uses illegal hallucinogenic drugs. ANS: A
The MMSE is a tool used to quantitatively estimate cognitive function or to serially document cognitive changes. Getting lost in a familiar territory is a sign of possible cognitive impairment. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 67 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Under most conditions, adult patients should be able to repeat a series of _____________
numbers. ANS:
five to eight Most adults should be able to immediately recall a series of five to eight numbers forward and a series of four to six numbers backward. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The examiner should be concerned about neurologic competence if a social smile cannot be
elicited by the time a child is _________ old.
ANS:
3 months A social smile is expected in the 2- to 3-month-old infant. If it is difficult or impossible to elicit a social smile by 3 months, the infant may not be neurologically intact. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 72 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following clinical assessments will test attention span? a. Spell WORLD backward. b. Draw a clock. c. Say the days of the week. d. Do arithmetic calculations. e. Explain “a stitch in time saves nine.” ANS: A, C, D
Clinical assessments to test attention span include spell WORLD backward, say the days of the week, and do arithmetic calculations. Drawing a clock tests writing ability, and explaining a “stitch in time saves nine” tests abstract reasoning. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 70 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which of the following are signs and symptoms of dementia? a. Aphasia b. Apathy c. Odd behaviors d. Disintegration of personality e. Lack of awareness of others ANS: A, B, D
Aphasia, apathy, and disintegration of personality are all characteristics of dementia. Odd behaviors and lack of awareness of others are characteristics of autism. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 78 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 06: Growth and Measurement Test Bank—Nursing MULTIPLE CHOICE 1. The gonads begin to secrete estrogen and testosterone during: a. infancy. b. puberty. c. pregnancy. d. early adulthood. ANS: B
At puberty, the gonads secrete testosterone and estrogen. As a result, secondary sex characteristics (e.g., genitalia growth) begin to appear. Maturation occurs at a mean age of 11.5 years in females and 13.5 years in males. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 79 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Developmental changes of puberty are caused mainly by the interaction of the pituitary gland,
gonads, and: a. hypothalamus. b. islet cells. c. thalamus. d. thymus. ANS: A
Under the influence of the hypothalamus, pituitary gland, and gonads, developmental changes of puberty are established. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 79 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. After 50 years of age, stature: a. becomes fixed. b. begins a barely perceptible secondary increase. c. increases at a rate of 0.5 cm/ year. d. declines. ANS: D
As the individual reaches 50 years of age, the intervertebral disk begins to thin and become more compressed, which leads to a decline in stature. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 82 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. By 10 to 12 years of age, lymphatic tissues are about: a. 25% of adult size. b. 50% of adult size. c. the same as adult size. d. twice the size of those in the adult.
ANS: D
Lymphatic tissues are small compared with total body size, but they are almost fully developed at birth. They grow fast and are about twice the adult size by age 10 to 12 years. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Jones has brought her 24-month-old child for a well visit. Which organ(s) completes
physical development more quickly than any other body part? a. Brain b. Kidneys c. Heart d. Lungs ANS: A
Along with the skull, eyes, and ears, the brain completes development more quickly than any other part of the body; its most rapid growth occurs from conception to age 2 years. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. During adolescence, the head size normally increases as a result of: a. sinus development. b. brain mass increase. c. evolution of lymphatic tissue. d. hypertrophy of myelin. ANS: A
As the facial sinuses grow, the head size enlarges its surface area to accommodate their growth. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 81 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Fifty percent of an individual’s ideal weight is gained during: a. pregnancy. b. preschool years. c. adolescence. d. early adulthood. ANS: C
During adolescence, the trunk and legs grow the most, causing the organs and the skeletal mass to double in size. In pregnancy, weight gain is accounted for by the growing fetus and pregnancy organs (placenta and uterus). In preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In early adulthood, there is a reduction in size and weight. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 81 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. Gender-specific skeletal differences first occur during: a. the second stage of fetal development. b. late infancy. c. early childhood. d. adolescence. ANS: D
During adolescence, females develop a wider pelvis and males develop broad shoulders; males transition from a slight increase in body fat to more lean muscle mass in later puberty, whereas females maintain an increase in adipose tissue throughout adolescence. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mrs. Layton is a 33-year-old patient who is obese. Most adult obesity begins: a. in adolescence. b. in childhood. c. after the skeletal growth is completed. d. once sexual maturation is complete. ANS: A
Seventy percent of adult obesity begins in adolescence, before skeletal growth or sexual maturation is complete. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The legs are the fastest growing body part during: a. early infancy. b. late infancy. c. childhood. d. early adulthood. ANS: C
Legs grow the fastest during childhood, whereas the trunk grows fastest in infancy and the skeletal muscles and organs grow fastest in early adulthood. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 81 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Skeletal mass and organ systems double in size during: a. infancy. b. early childhood. c. adolescence. d. early adulthood. ANS: C
During puberty, sex steroids stimulate secretion of growth hormone, causing the organs and skeletal mass to double in size. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. Optimal infant birth weight is difficult for pregnant adolescents to obtain because: a. they have not completed their own growth spurt. b. there are insufficient uterine supporting structures. c. the amniotic fluid is variable in pregnant adolescents. d. blood volume has not reached adult proportions. ANS: A
Pregnant adolescents younger than 16 years, or less than 2 years from menarche, may still be in their growth spurt. They may require higher weight gains during pregnancy to achieve an optimal infant birth weight. There are sufficient uterine supporting structures in the pregnant adolescent. The amnionic fluid is not variable in pregnant adolescents. Blood volume has reached adult proportions in the pregnant adolescent. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 90 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. How much of the weight gained during a normal pregnancy is accounted for by the fetus? a. Less than 5 pounds b. 6 to 8 pounds c. 9 to 12 pounds d. 13 to 30 pounds ANS: B
The growing fetus accounts for only 6 to 8 pounds of the total weight gained. The remainder results from an increase in maternal tissues (e.g., placenta, amniotic fluid, uterus, blood and fluid volume, breasts, and fat reserves). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. The rate of weight gain during pregnancy is expected to be: a. greatest in the first trimester. b. greatest in the second trimester. c. greatest in the third trimester. d. about the same in each trimester. ANS: B
The rate of weight gain is slow during the first trimester, rapid during the second trimester, and less rapid during the third trimester. Maternal tissue growth accounts for most of the weight gained in the first and second trimesters, whereas fetal growth accounts for weight gained during the third trimester. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 80 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. During a preventive health care visit, Ms. G, an older patient, states that she is getting shorter.
She says that her son mentioned that her change in stature became noticeable to him during his last visit with her. Her posture appears straight and aligned. When addressing Ms. G.’s present concerns, it is most important to inquire about: a. the number of pregnancies. b. her parents’ heights.
c. a history of scoliosis. d. her usual height and weight. ANS: D
Stature declines after 50 years of age because of progressive thinning of the intervertebral disks, so it is important to determine the patient’s height and weight at this age as a baseline for future trending. DIF: Cognitive Level: Applying (Application) REF: p. 82 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Over the past 2 decades, there has been a trend toward: a. increased osteoporosis. b. preservation of height. c. obesity in older adults. d. preservation of muscle mass. ANS: C
An increase in overweight and obese older adults has been documented over the past 15 to 20 years. A decrease in weight for height and body mass index has been found with increasing age in patients between 70 and 89 years of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 82 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Milestone achievements are data most likely to appear in the history of: a. adolescents. b. infants. c. school-age children. d. young adults. ANS: B
As part of developmental assessment in infants, milestone achievements at certain ages, such as crawling, laughing, picking up their head, and turning over, are recorded. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 82 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. To estimate an individual’s frame size, the examiner should measure: a. skull circumference. b. the length from the olecranon process to the acromion process. c. elbow breadth. d. hip circumference. ANS: C
With the patient’s right arm extended and the elbow flexed to 90 degrees, measure the elbow breadth using a measuring device or skinfold calipers, held on the same plane as the upper arm, on the two most prominent bones of the elbow. DIF: Cognitive Level: Applying (Application) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
19. Which cultural group tends to have a wide variation in birth weights? a. Native Americans b. Filipinos c. Norwegians d. Puerto Ricans ANS: A
As much as a 362-g difference in mean birth weight exists among several Native American tribes. African American, Asian, Filipino, Hawaiian, and Puerto Rican infants generally weigh less than white infants. Filipinos, Norwegians, and Puerto Ricans do not have a wide variation in birth weights. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Healthy term babies generally double their birth weight by what age? a. 3 months b. 5 months c. 9 months d. 12 months ANS: B
In general, healthy infants double their birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age. Formula-fed infants are heavier after the first 6 months of life than breast-fed infants; they grow faster in the first 6 months of life and experience slower growth in the second 6 months of the first year. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 84 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Infants born to the same parents are normally within which range of weight of each other? a. 6 ounces b. 12 ounces c. 1 pound d. 2 pounds ANS: A
Siblings born at term to the same parents usually weigh within 6 ounces of each other. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 83 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A marker for nutritional status is the: a. head circumference. b. waist-to-hip ratio. c. standing height. d. triceps skinfold thickness. ANS: D
The measurement of skinfold or fatfold thickness provides another parameter to evaluate the nutritional status of the patient. The jaws of skinfold thickness calipers must be correctly placed to obtain an accurate reading.
DIF: Cognitive Level: Applying (Application) REF: p. 83 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. To measure head circumference, the tape is wrapped snugly around the child’s head at the
occipital protuberance and the: a. supraorbital prominence. b. brow line. c. nasal bridge. d. chin. ANS: A
The measuring tape should be snugly wrapped around the child’s head at the occipital protuberance and supraorbital prominence, thereby documenting the largest circumference. Care should be taken to ensure that the tape does not cut the skin. Make the reading to the nearest 0.5 cm or inch, and remember to remeasure the head circumference at least once to check the accuracy of your measurement. DIF: Cognitive Level: Applying (Application) REF: p. 84 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Between 5 and 24 months of life, the infant’s chest circumference is normally: a. about equal to the head circumference. b. greater than head circumference by 2 inches. c. smaller than head circumference by about 4 inches. d. at least 2 inches smaller than head circumference. ANS: A
Between the ages of 5 months and 2 years, the infant’s chest circumference should closely approximate the head circumference; the ratio should be monitored so that possible microcephaly can be identified. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 85 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s: a. length. b. weight. c. lung maturity. d. gestational age. ANS: D
The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics and is administered within 36 hours of birth to confirm the newborn’s gestational age. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 85 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. Which of the following situations poses the most concern? a. The child whose weight and height ratios have remained at the 50th percentile b. The child whose weight and height ratios have stayed between the 90th and 95th
percentiles c. The child whose weight and height ratios have never been above the 50th percentile d. The child whose weight and height ratios have dropped 15 percentiles since the last visit ANS: D
Over time, interval measurements should demonstrate that the child has established a growth pattern, indicated by consistently following a percentile curve on the growth chart. Greatest concern is for the child who is trending down in a more dramatic fashion. Children who suddenly fall below or rise above their established percentile growth curve should be examined more closely to determine the cause. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 82 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. The upper-to-lower segment ratio should be calculated: a. bimonthly for the first year of life. b. annually for the first 5 years. c. only when a child is suspected of having a growth problem or unusual body
proportions. d. in children of first-generation immigrants. ANS: C
The upper-to-lower segment ratio is calculated when a child is suspected of having a growth problem or unusual body proportions. DIF: Cognitive Level: Applying (Application) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. A Mexican American mother brings her 12-year-old daughter to the clinic because this child is
not maturing as quickly as her classmates. You examine the daughter and determine that her growth and physical findings are within normal limits. You should explain to the family that: a. Mexican Americans may develop more slowly than other ethnic groups. b. more tests should be conducted because the family appears so worried. c. the daughter should drink more juices and eat more fruit. d. there is a serious problem with the daughter’s development. ANS: A
Mexican Americans typically are taller than Asian children but shorter than Native American, white, and African American children. This child’s growth pattern should be similar to other children of similar ethnicity. More tests are not required. The daughter does not need to drink more juices and eat more fruit. There is no problem with the daughter’s development. DIF: Cognitive Level: Applying (Application) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Which of following statements regarding female pubertal changes is true? a. Most adolescent girls will develop breasts before they develop pubic hair. b. Peak height velocity should occur after menarche. c. Breast asymmetry is an abnormal finding. d. Menarche should occur by Tanner breast stage 2.
ANS: A
In two thirds of the population of girls, breasts begin to develop before pubic hair. Peak height velocity actually occurs about 1 year before menarche, breast asymmetry is common, and menarche occurs after Tanner breast stage 2. Peak height velocity will not occur after menarche. Breast asymmetry is not an abnormal finding. Menarche does not generally occur by Tanner breast stage 2. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. At what age does peak height growth velocity occur in boys? a. 10 years b. 12 years c.
years
d.
years
ANS: C
Peak height velocity occurs at an average age of
years in boys.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. What is the youngest age at which pubic hair growth in the male may be considered normal? a. 7 years b. 8 years c. 9 years d. 10 years ANS: C
In males, sexual development before 9 years of age is precocious puberty and is considered an abnormal finding; sexual development after 9 years of age is considered normal puberty. DIF: Cognitive Level: Applying (Application) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. Which Tanner stage is marked by the most significant growth in penis length? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 ANS: C
Tanner stage 3 is marked by enlargement of the penis, especially in length. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 90 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Which Tanner stage corresponds to a secondary areola mound development above the breast? a. Stage 2 b. Stage 3
c. Stage 4 d. Stage 5 ANS: C
Tanner stage 4 depicts the stage at which the areola forms a second mound above the breast. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 88 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. A pregnant woman of normal prepregnancy weight should be expected to gain how much
weight per week during the second and third trimesters of pregnancy? a. 1 pound b.
pounds c. 2 pounds d.
pounds
ANS: A
Expected weight gain in the first trimester is variable, between 1 and 2 kg (2 to 4 pounds); however, in the second and third trimesters, weekly weight gain should be approximately 0.45 kg (1 pound) per week. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 89 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. A prominent forehead, large nose, large jaw, and elongation of the facial bones and extremities
are signs of: a. infantile hydrocephalus. b. acromegaly. c. Cushing syndrome. d. achondroplasia. ANS: B
A prominent forehead, large nose, large jaw, and elongation of the facial bones and extremities are all prominent characteristics of acromegaly; a prominent forehead can also occur with achondroplasia, but hypoplasia of the midface differentiates the two. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 92 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Round face, preauricular fat, hyperpigmentation, and “buffalo hump” in the posterior cervical
area are associated with: a. infantile hydrocephalus. b. acromegaly. c. Cushing syndrome. d. achondroplasia. ANS: C
Round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical area are all commonly associated with Cushing syndrome; the buffalo hump distinguishes Cushing syndrome from the other choices.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 92 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. A woman with a normal prepregnancy body mass index (BMI) should gain approximately
_____ pounds during pregnancy. ANS:
30 Women of normal BMI should expect to gain between 25 and 35 pounds during pregnancy. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 89 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. An 11-year-old boy is brought in for an annual physical examination by his mother. You
suspect _______________ when you measure his arm span at 65 inches and his height at 60 inches. ANS:
Marfan syndrome Arm span that is greater than a child’s height is associated with Marfan syndrome. Children with Marfan syndrome can have cardiovascular problems and should be thoroughly evaluated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 87 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Infants normally increase their birth length by ____% during the first year of life. ANS:
50 Infant length generally increases by 50% in the first year of life. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 84 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The term large for gestational age (LGA) indicates that an infant is larger than ____% of
infants born at the same number of weeks’ gestation. ANS:
90 LGA corresponds to an infant whose weight is classified as greater than the 90th percentile. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 86 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE 1. Which of the following are signs and symptoms of hydrocephalus? (Select all that apply.) a. Early closed suture lines b. Hyperreflexia c. Irritable, poor feeding d. Does not meet expected height and weight e. Difficulty holding head up f. Rapidly increasing head circumference ANS: B, C, E, F
Signs and symptoms of hydrocephalus include enlarged head, difficulty holding head up, irritable, lack of energy, and poor feeding. Rapidly increasing head circumference, tense, full, or bulging fontanel, increased tone, or hyperreflexia do not indicate hydrocephalus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 93 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 07: Nutrition Test Bank—Nursing MULTIPLE CHOICE 1. Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her
current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient? a. Iron b. Thiamine c. Calcium d. Fat ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. Iron, thiamine, and calcium are minerals. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 95 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Macronutrients are so named because they: a. have high molecular weights. b. form long chemical chains. c. tend to increase waist measurements. d. are required in large amounts. ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 95 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The body handles excess carbohydrate ingestion by: a. storing it as fat. b. raising the metabolic rate. c. excreting it in urine and stool. d. enzyme degradation. ANS: A
Excess carbohydrates, not used for fueling the body’s demands, are stored in fatty tissues. The body does not handle excess carbohydrate ingestion by raising the metabolic rate or by enzyme degradation. Excess carbohydrate is not excreted; it is stored. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. A college student comes to the student health center complaining of difficulty in concentrating
during class and while studying. The diet that would contribute to this problem is one that contains mostly: a. fruit and vegetables.
b. lean meat and fish. c. sandwiches and diet drinks. d. pasta and chicken. ANS: B
Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. Fruits and vegetables, sandwiches and diet drinks, and pasta and chicken have moderate levels of needed carbohydrates. DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 95-96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way
and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as: a. providing an energy source for the brain. b. building and maintaining tissues. c. participating in specific detoxifying metabolic pathways. d. synthesizing and regulating hormones. ANS: B
The major functions of proteins include building and maintaining tissues, regulating water and acid-base balance, and acting as precursors for enzymes, antibodies, and several hormones. Carbohydrates, not proteins, provide an energy source for the brain. Proteins do not participate in detoxifying metabolic pathways or synthesize and regulate hormones. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Miles is a 45-year-old man who is being evaluated for obesity. Advising Mr. Miles to
reduce which macronutrient will produce the greatest calorie reduction per gram? a. Carbohydrate b. Protein c. Fat d. All provide the same number of calories per gram. ANS: C
Reducing fats will produce the greatest calorie reduction per gram. Carbohydrates and proteins supply 4 calories per gram, and fats supply 9 calories per gram. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. In counseling a client regarding nutrition education, you explain that linoleic acid, a major
fatty acid, is thought to be essential for: a. glycogen storage in the liver. b. normal growth and development. c. myocardial cell function. d. building and maintaining tissues. ANS: B
Linoleic acid, found abundantly in milk and dairy fats, is required for normal growth and development. Recently, it has been suggested that it can reduce body fat in overweight persons, as well as having cancer-fighting properties. Carbohydrates provide for glycogen storage and energy for myocardial cell function. Proteins are essential for building and maintaining tissues. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination,
you note costochondral beading, an enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets? a. Vitamin A b. Vitamin E c. Vitamin D d. Vitamin K ANS: C
Diets deficient in vitamin D can cause rickets. Today, milk is fortified with vitamin D; therefore, rickets is seldom seen in the United States. Vitamin A deficiency causes night blindness, dry eyes, and poor bone growth. Vitamin E deficiency causes hyporeflexia, retinal degeneration, and red cell hemolysis in malnourished infants. Vitamin K deficiency results in prolonged bleeding and prothrombin time, which are hemorrhagic manifestations. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 103 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B
vitamin is deficient in patients with pernicious anemia? a. B1 b. B2 c. B6 d. B12 ANS: D
Vitamin B12 deficiency can result in pernicious anemia. Vitamin B1 deficiency results in beriberi. Vitamin B2 deficiency results in scaling skin, glossitis, and burning, itching, and sensitive eyes. Vitamin B6 deficiency results in weak gait, irritability, neuropathy, and convulsions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 104 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Mrs. Wade is a 51-year-old patient who presents for a follow-up visit. In reviewing her
nutritional history and diagnostic studies, you have diagnosed her with osteoporosis. Deficiency of which micronutrient is implicated in osteoporosis? a. Phosphorus b. Calcium c. Iron d. Zinc ANS: B
Ninety-nine percent of bone is composed of calcium. A deficiency in calcium would lead to osteoporosis. Phosphorus deficiency is rare. Iron deficiency results in pallor, lethargy, anorexia, and hypochromic microcytic anemia. Zinc deficiency results in decreased wound healing, hypogonadism, anemia, hair loss, diarrhea, and altered taste. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 105 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Mr. Williams, a 62-year-old patient, presents for a physical examination. You suspect a
vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency? a. Spinal curvature and bowed legs b. Night blindness and dry eyes c. Neuropathy and seizures d. Nausea and insomnia ANS: A
Vitamin D deficiency can lead to rickets, a disease manifested by spinal curvature and bowed legs. Night blindness and dry eyes result from vitamin A deficiency. Neuropathy and convulsions result from vitamin B6 deficiency. Nausea and insomnia result from a biotin deficiency. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 103 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Which of the following is the most vital nutrient? a. Protein b. Carbohydrate c. Fat d. Water ANS: D
Water is the most vital nutrient. A person can exist without food for several weeks but without water for only a few days. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Under normal circumstances, how much water is lost daily by the body? a. 1 to 1.5 liters b. 2 to 2.5 liters c. 3 to 4 liters d. 5 to 6 liters ANS: B
Under normal circumstances, approximately 2 to 2.5 liters of water is lost daily. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. The largest proportion of total energy expenditure by the body occurs through: a. thermogenesis.
b. digestive processes. c. resting energy. d. physical activity. ANS: C
Resting energy expenditure contributes the largest proportion of total energy expenditure by the body. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 97 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Which of the following is the most accurate reflection of an individual’s food intake? a. Twenty-four-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assay ANS: B
The food diary is a record of intake as it happens, making this method the most accurate reflection of an individual’s food intake. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 101 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she
is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? a. Ascorbic acid b. Vitamin B12 c. Folate d. Fiber ANS: B
The nutrients that may be deficient in a vegetarian diet, if not carefully planned, include proteins, calcium, iron, vitamin B12, and vitamin D. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 102 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. When using rule of thumb estimates of energy needs of healthy adults, how many kcal/kg are
required to maintain the individual’s current weight? a. 20 b. 30 c. 40 d. 50 ANS: B
The requirement for weight maintenance is 30 kcal/kg. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 102-103 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Which age group requires the highest percentage of dietary fat intake?
a. b. c. d.
Infants and children up to 2 years of age Children between 2 and 10 years of age Adolescents Older adults
ANS: A
Before 2 years of age, fat intake may reach 35% to 40% of calories. Children between 2 and 10 require 25% to 35% of calories. Adolescents require 25% to 35% of calories. Older adults require 25% to 35% of calories. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 102 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which
medication is frequently associated with weight gain? a. Diuretics b. Oral hypoglycemics c. Laxatives d. Steroids ANS: D
Medications that contribute to weight gain include steroids, oral contraceptives, antidepressants, and insulin. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 97 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Ms. A’s major risk factor for developing an eating disorder is having: a. parents who stress academia and social acceptance. b. a first-degree relative with an eating disorder. c. siblings who are low academic achievers. d. parents who stress the importance of the food pyramid. ANS: B
A major risk factor for an eating disorder is having a family history of eating disorders, especially in a first-degree relative. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 99 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Monitoring a patient’s waist-to-hip ratio provides data concerning: a. daily caloric requirements. b. lung capacity. c. stomach cancer risk. d. cardiovascular disease risk. ANS: D
Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular risk factors. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 100 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
22. Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would
be: a. b. c. d.
normal body weight. overweight. obese. extremely obese.
ANS: C
An obese BMI is 30 to 39.9. A normal BMI is less than 24. An overweight BMI is 25 to 29.9. An extremely obese BMI is greater than 40. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 110 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings
reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: a. binges and vomits. b. has regular menstrual periods. c. has constipation frequently. d. is cold intolerant. ANS: A
In young adults, usually female, bradycardia, knuckle scars, and tooth decay are signs of chronic, self-induced vomiting characteristic of bulimia. Amenorrhea can occur from increased physical activity or anorexia. Constipation and cold intolerance are usually symptoms of anorexia nervosa. DIF: Cognitive Level: Applying (Application) REF: p. 112 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. The recommended carbohydrate content of total dietary intake (% total calories) is ____%. ANS:
50 Fifty percent of total caloric intake should be from carbohydrates. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The recommended minimum daily protein requirement for the normal adult is ______. ANS:
10% to 35% of total calories It is recommended that the protein content of the diet be 10% to 35% of total calories, or 45 g in adults.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. You are using the rule of thumb for advising a 150-pound person regarding the appropriate
number of calories to promote weight loss. Your advice is for the person to consume no more than _____ calories daily. ANS:
1700 The person weighs 68 kg, so multiplying by 25 (rule of thumb for weight loss) equals 1700 calories. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 102 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The adult recommended dietary fat intake should be _____ g/day. ANS:
20 to 35 It is recommended that fat content of the diet be 20 to 35 g/day. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 96 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Nutrient composition for the Therapeutic Lifestyle Changes diet include which of the
following: (Select all that apply.) a. Saturated fat less than 4% b. Total fat, 25% to 35% c. Carbohydrates, 40% d. Fiber, 30 g/day e. Monounsaturated fat, up to 20% cal f. Cholesterol, 250 mg/ day ANS: B, D, E
The nutrient composition for the Therapeutic Lifestyle Changes diet include polyunsaturated fat, up to 10%, monounsaturated fat, up to 20%, total fat, 25% to 35%, fiber, 20 to 30 g/day, protein, 15% of calories, and cholesterol, 200 mg/day. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 113 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 08: Skin, Hair, and Nails Test Bank—Nursing MULTIPLE CHOICE 1. The skin repairs surface wounds by: a. exaggerating cell replacement. b. excreting lactic acid. c. producing vitamins. d. providing a mechanical barrier. ANS: A
The skin’s tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the skin to repair damaged surfaces. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 115 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The adipose tissue in the hypodermis serves to: a. provide sensory input. b. generate heat and insulate. c. create tensile strength. d. secrete collagen. ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and provide insulation, shock absorption, and a reserve of calories. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 115 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Sweat glands, hair, and nails are all formed from: a. basement membranes under cellular strata. b. closely packed squamous cells. c. invaginations of epidermis into dermis. d. papillae that penetrate the epidermis. ANS: C
Skin appendages are formed embryonically when the epidermis invaginates into the dermis. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 115 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The secretory activity of the sebaceous glands is stimulated by: a. body heat. b. ambient temperature. c. sex hormones. d. dietary protein. ANS: C
The sebaceous glands, when stimulated by the sex hormones, produce a lipid-rich substance that keeps the skin moist. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 116 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her
fingernails are not growing. Which structure is the site of new nail growth? a. Cuticle b. Perionychium c. Matrix d. Nail bed ANS: C
The white crescent-shaped area beyond the proximal nail fold is called the matrix, which is the site of new nail growth. DIF: Cognitive Level: Applying (Application) REF: p. 116 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby
visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia because of: a. the presence of coarse terminal hair. b. desquamation of the stratum corneum. c. their covering of vernix caseosa. d. a poorly developed subcutaneous fat layer. ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 116 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Mrs. Mulligan brings her 16-year-old son into the office for a sports physical examination. As
the health care provider, you explain that normal hormone-related changes of adolescence include: a. increased oil production. b. slowed hair growth. c. depleted apocrine glands. d. decreased sebaceous gland activity. ANS: A
During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 116 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Expected hair distribution changes in older adults include: a. increased terminal hair follicles on the scalp.
b. more prominent axillary and pubic hair production. c. increased terminal hair follicles to the tragus of men’s ears. d. more prominent peripheral extremity hair production. ANS: C
The transition from a vellous to terminal hair pattern occurs in older men at the nares and tragus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 117 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Brittle nails are typical findings in: a. adolescents. b. infants. c. pregnant women. d. older adults. ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails to develop longitudinal ridges that are more brittle and susceptible to splitting into layers. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 117 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Mrs. Franklin is a 68-year-old patient who presents to the office with a complaint that her
nails do not seem to be growing. As the health care provider, you explain to her that the nails of older adults grow slowly because of: a. decreased circulation. b. dietary deficiencies. c. fungal infections. d. low hormone levels. ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 117 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. As part of your health promotion education for a new patient, you explain that the risk factors
for skin cancer include: a. an olive complexion. b. repeated trauma or irritation to skin. c. history of allergic reactions to sunscreen. d. dark eyes and hair. ANS: B
Fair-skinned persons with light eyes with repeated trauma or skin irritation have higher risk factors for skin cancer development. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 117 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. The type and brand of grooming products used are important to the health history of: a. adolescents. b. everyone. c. older adults. d. persons with rashes. ANS: B
Knowledge of exposure to environmental chemicals is valid health history data for all age groups, not just adolescents, older adults, or persons with rashes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 118 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin
is best conducted: a. using an episcope. b. under fluorescent lighting. c. with illumination provided by daylight. d. using a Wood’s light. ANS: C
Daylight provides the best illumination source for determining color variations of the skin. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 119 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Tangential lighting is best used for inspecting skin: a. color. b. contour. c. exudates. d. symmetry. ANS: B
Tangential lighting—light shined laterally to the surface—is best for inspecting skin contour. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 120 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Unusual white areas on the skin may be caused by: a. adrenal disease. b. polycythemia. c. vitiligo. d. Down syndrome. ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 122 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Which cultural group has the lowest incidence of nevi? a. Native Americans
b. African Americans c. Mexican Americans d. Asians ANS: B
Nevi are more common in persons who burn, rather than tan; therefore, African Americans have the lowest rates of nevi. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 121 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. You are inspecting the lower extremities of a patient and have noted pale, shiny skin of the
lower extremities. This may reflect: a. systemic disease. b. a history of vigorous exercise. c. peptic ulcer disease. d. mental retardation. ANS: A
Pale, shiny skin of the lower extremities may reflect peripheral changes that occur with systemic disorders, such as diabetes mellitus and cardiovascular disease. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 123 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. A 29-year-old white woman appears jaundiced. Liver disease as a cause has been excluded.
What history questions should the nurse ask? a. Whether she had unprotected sex b. Whether she has a history of diabetes mellitus c. Whether she had unusual bleeding problems d. Whether she eats a lot of yellow and orange vegetables ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced. Whether she had unprotected sex, a history of diabetes mellitus, or unusual bleeding problems would not be relevant when assessing the jaundiced skin. DIF: Cognitive Level: Applying (Application) REF: p. 119 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Mrs. Bower is a 39-year-old patient who has come to the office for a routine physical
examination. As the health care provider, you know that the skin temperature is best assessed with the: a. dorsal surface of the examiner’s hand. b. palmar surface of the examiner’s hand. c. ulnar surface of the examiner’s hand. d. pads of the examiner’s fingers. ANS: A
The dorsal surface of the hand is best for estimating temperature variations.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 124 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. You are examining a pregnant patient and have noted a vascular lesion. When you blanch over
the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a: a. telangiectasia. b. spider angioma. c. petechiae. d. purpura. ANS: B
Spider angiomas are dilated arterioles. A network of dilated capillaries radiate from the center arteriole, outward like a spider’s legs. Spider angiomas are often associated with high estrogen levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Telangiectasis refill erratically. Petechiae and purpura do not blanch. DIF: Cognitive Level: Applying (Application) REF: p. 123 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Small, minute bruises are called: a. ecchymoses. b. petechiae. c. spider veins. d. telangiectasias. ANS: B
Petechiae are smaller than 0.5 cm in diameter. Ecchymoses are larger than 0.5 cm in diameter. Spider veins and telangiectasias are vascular lesions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 124 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A flat, nonpalpable lesion is described as a macule if the diameter is: a. larger than 1 cm. b. smaller than 1 cm. c. 3 cm exactly. d. too irregular to measure. ANS: B
A macule, by definition, is a flat, circumscribed area smaller than 1 cm in diameter and is measurable. An example of a macular rash is measles. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 126 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes.
You have noted a 4- 3-cm, rough, elevated area of psoriasis. This is an example of a: a. plaque. b. patch. c. macule.
d. papule. ANS: A
A plaque, by definition, is an elevated, firm, rough lesion with a flat top surface larger than 1 cm in diameter, as seen in someone with, for example, psoriasis. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 126 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. The nurse inspects an annular lesion. Which type of additional lighting source should be used
for further assessment? a. Fluorescent lighting b. Wood’s lamp c. Goose-neck lamp d. Sunlight ANS: B
Annular lesions are characteristic of tinea, which are fluorescing lesions that illuminate as yellow-green under a Wood’s lamp. DIF: Cognitive Level: Applying (Application) REF: p. 133 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Skin turgor checks are performed to determine the: a. temperature of the skin. b. hydration status. c. actual age. d. extent of an ecchymosis. ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 140 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. You have just completed a skin assessment on Mr. Baker. During your assessment, you have
transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish: a. vascular from nonvascular lesions. b. furuncles from folliculitis lesions. c. fluid-filled lesions from solid cysts or masses. d. herpes zoster from varicella. ANS: C
Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions will transilluminate with a red glow, and solid masses will not transilluminate. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 133 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Fluorescing lesions are best distinguished using a(n): a. incandescent lamp.
b. magnifying glass. c. transilluminator. d. Wood’s lamp. ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a Wood’s lamp. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 133 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Women with terminal hair growth in a male distribution pattern should receive further
evaluation for a(n): a. circulation condition. b. endocrine disorder. c. inflammatory state. d. nutritional deficit. ANS: B
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of an endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or nutritional deficits. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 155 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Which nail change found on examination would be most alarming? a. Dark bands seen on all fingernails of a dark-skinned person b. Yellow discoloration of the great toe of an older adult c. Single dark band in a white adult d. Pits in both index fingernails of an adult ANS: C
Dark bands in a dark-skinned person are normal; yellow in the toe of an older adult can represent a nail disease or a chronic respiratory condition; and pits are related to psoriasis. A single dark band in a white adult indicates a more serious condition—melanoma. DIF: Cognitive Level: Applying (Application) REF: p. 134 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Transient mottling of the patient’s skin in a cool room is a common finding in: a. menopausal women. b. newborn infants. c. pregnant women. d. sedentary adults. ANS: B
Cutis marmorata, a mottled appearance, is part of the newborn’s response to changes in temperature. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 137 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
31. A single transverse line seen in the palm of a small child may imply: a. Down syndrome. b. Turner syndrome. c. systemic sclerosis. d. profound dehydration. ANS: A
The simian line, a single transverse crease, is seen on the palm of children with Down syndrome. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 138 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. Café au lait patches are numbered with each assessment of infants and young children
because: a. the numbers are expected to increase each year. b. coalescent lesions are a more serious finding. c. the presence of more than five patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. ANS: C
The presence of more than five patches with diameters larger than 1 cm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches is usually considered harmless. The numbers of café au lait patches are not expected to increase each year. Coalescent lesions are not a more serious finding. Decreasing numbers are not expected with growth. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 137 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. A Dennie-Morgan fold is probably caused by: a. birth trauma. b. high fever. c. excess adipose tissue. d. chronic rubbing. ANS: D
Persons with chronic atopic or allergic conditions tend to rub the eyes sufficiently to cause an extra crease or pleat of skin below the eye, called the Dennie-Morgan fold. DIF: Cognitive Level: Applying (Application) REF: p. 140 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. Linea nigra is commonly found on the abdomens of: a. infants and children. b. adolescents. c. pregnant women. d. older adults. ANS: C
Pregnant women commonly develop pigmentation of the abdomen from the symphysis pubis to the top of the fundus in the midline. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 140 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Cherry angiomas are a common finding in: a. adults older than 30 years. b. newborns. c. pregnant women. d. sunbathers. ANS: A
Cherry angiomas occur in almost everyone older than 30 years and increase numerically with age. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 142 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced
practitioner who can distinguish: a. cutaneous tags from lentigines. b. furuncles from folliculitis. c. sebaceous hyperplasia from eczema. d. seborrheic keratoses from actinic keratoses. ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 142 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. Age spots are also called: a. seborrheic keratoses. b. solar lentigines. c. cutaneous horns. d. acrochordon. ANS: B
Solar lentigines are irregular, round, gray-brown lesions with a rough surface that occur in sun-exposed areas and are referred to as age spots. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 143 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. The most common inflammatory skin condition is: a. cutis marmorata. b. eczematous dermatitis. c. intradermal nevus. d. pityriasis rosea.
ANS: B
The most common inflammatory skin disorder is eczematous dermatitis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 144 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Which of the following is a noncandidal fungal infection? a. Pityriasis rosea b. Psoriasis c. Tinea corporis d. Rosacea ANS: C
Tinea corporis is the only listed fungal infection (noncandidal); the others are not fungal in origin. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 146 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. The characteristic that best differentiates psoriasis from other skin abnormalities is the: a. color of the scales. b. formation of tiny papules. c. general distribution over the body. d. recurrence. ANS: A
Unlike other skin conditions, silvery papules and plaques characterize psoriasis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 146 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Painful vesicles are associated with: a. psoriasis. b. pityriasis rosea. c. paronychia. d. herpes zoster. ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 148 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval
plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse’s next action? a. Teach infectious control measures. b. Inquire about another recent skin lesion. c. Inspect the palms and the soles. d. Inform the patient that this will resolve within a week. ANS: B
The described rash is the typical presentation of pityriasis rosea. The rash is not infectious or contagious, does not involve the palms and soles, and usually lasts for several weeks. Pityriasis rosea begins with a sudden primary (herald) patch, with generalized eruption to the trunk and extremities following 1 to 3 weeks later. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 148 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. Which of the following is an ABCD characteristic of malignant melanoma? a. Asymmetric borders b. Borders well demarcated c. Color of lesion is uniform d. Diameter less than 6 mm ANS: A
ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter larger than 6 mm and growing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 154 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. The most common cutaneous neoplasm is: a. basal cell carcinoma. b. compound nevus. c. seborrheic keratosis. d. senile actinic keratosis. ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on sun-exposed parts of the body. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 152 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. Soft, painless, bluish papules in persons who are HIV-positive are most likely: a. Kaposi sarcoma. b. malignant melanoma. c. molluscum contagiosum. d. pityriasis rosea. ANS: A
Kaposi sarcoma is the more common malignant skin lesion of HIV-infected persons. The lesions are soft, painless, bluish-purple macules or papules. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 153 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. A 5-year-old child presents with discrete vesicles on an erythematous base (dew drops on a
rose petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action? a. Teach infectious control measures. b. Inquire about other patterns of physical abuse.
c. Inspect the buccal mucosa for Koplik spots. d. Inform the parent that this will resolve within a couple of days. ANS: A
The description of this child’s complaint is a varicella rash, not physical abuse or rubeola. Chickenpox is a highly communicable disease and can be prevented by immunization. The period of communicability lasts from 1 or 2 days before onset of the rash until all the vesicles have crusted over, which usually takes about 1 week. This is not physical abuse. Inspecting the buccal mucosa for Koplik spots will not diagnose the problem. This will not resolve within a couple of days. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 161 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. During history taking, a mother states that her son awoke in the middle of the night
complaining of intense itching to his legs. Today, your inspection reveals a honey-colored exudate from the vesicular rash on his legs. Which condition is consistent with these findings? a. Exanthem b. Impetigo c. Solar keratoses d. Trichotillomania ANS: B
Impetigo causes intense pruritus, regional lymphadenopathy, and honey-colored exudative crusting as the vesicles or bullae rupture and dry. DIF: Cognitive Level: Applying (Application) REF: p. 160 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. You are conducting a preschool examination on a 5-year-old child. Which injury would most
likely raise your suspicion that the child was being abused? a. Recent bruising over both knees b. A healed laceration under the chin c. A bruise on the right shin with associated abrasion of tissue d. Bruises in various stages of resolution over body soft tissues ANS: D
Toddlers and older children who bruise themselves accidentally do so over bony prominences, like the knees, chin, and shin. Bruises over soft tissues are more consistent with abuse. DIF: Cognitive Level: Applying (Application) REF: p. 163 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older
adults indicates: a. sexual abuse. b. physical neglect. c. psychological abuse. d. violated rights. ANS: B
Described is the most common form of elder abuse, physical neglect.
DIF: Cognitive Level: Applying (Application) REF: p. 165 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. The nurse assesses the nail base angle using the Schamroth technique. The normal expected
examination finding is nail beds that are _____ at the bases. a. flat b. convex c. concave d. bowed ANS: C
The normal nail base angle should be 160 degrees, which results in a concave nail base that produces a diamond-shaped window with the Schamroth technique. DIF: Cognitive Level: Applying (Application) REF: p. 135 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. A slightly elevated brownish papule with indistinct borders is a typical characteristic of a(n)
_____ nevus. ANS:
compound Only a compound nevus is slightly elevated and brown, with indistinct borders. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 121 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Individuals with dark pigmentary demarcation lines show lighter coloration on ________
body surfaces. ANS:
inward Individuals with pigmentary demarcation lines have darker skin on the outward-facing surfaces and lighter skin on the inward-facing surfaces. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 121 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Damage into the subcutaneous tissue in a decubitus ulcer occurs at stage _____. ANS:
III Stage III describes damage through to the subcutaneous tissue. DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 142
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE 1. Which of the following identify the signs and symptoms of basal cell cancer? (Select all that
apply.) a. Itching b. Reddish patch c. Starts from a nevi d. Various clinical forms—cystic, nodular, pigmented e. Macule type ANS: A, B, D
Common signs and symptoms of basal cell carcinoma include a, pink, red, tan, white, black, or brown shiny nodule, in a variety of clinical forms, which may be crusted and itching. DIF: Cognitive Level: Applying (Application) REF: p. 152 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 09: Lymphatic System Test Bank—Nursing MULTIPLE CHOICE 1. Which of the following organs does not have lymphatic vessels? a. Brain b. Kidneys c. Liver d. Lungs ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system). Lymphatic tissues are found abundantly in the kidneys, liver, and lungs. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 166 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Cells that line the lymph node sinuses perform the specific function of: a. fat absorption. b. fetal immunization. c. hematopoiesis. d. phagocytosis. ANS: D
Lymph nodes defend against the invasion of microorganisms by phagocytosis. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 166 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Lymph ducts merge into the venous system at the: a. portal vein. b. pulmonic vein. c. subclavian vein. d. vena cava. ANS: C
The large ducts of the lymphatics merge into the venous system at the subclavian vein. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 167 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Lymph flows faster in response to: a. increased metabolic activity. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, or increased metabolic rate. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 167 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. An organ that is essential to the development of protective immune function in the infant but
has little or no demonstrated function in the adult is the: a. spleen. b. liver. c. thymus. d. pancreas. ANS: C
In the adult, the thymus atrophies and, in the older adult, is replaced by fat and connective tissue. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 170 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Shea is a 45-year-old patient who presents to the office for multiple complaints. The
examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of the immune system because of the location of which organ? a. Spleen b. Liver c. Stomach d. Pancreas ANS: A
The spleen is the largest of the lymphatic organs. It is located in the upper left portion of the abdomen. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 167 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Mrs. Farrel brings in her 6-year-old son with complaints of a sore throat and fever. As the
health care provider, you are concerned about his tonsils and adenoids. Enlarged tonsils and adenoids may obstruct the: a. thoracic duct. b. esophagus. c. nasopharyngeal passageway. d. external auditory meatus. ANS: C
The palatine tonsils are located on either side of the pharynx; the adenoids (pharyngeal tonsils) are found on the posterior wall of the pharynx and superior to the soft palate. If these structures become enlarged, they block the passage between the pharynx and nasal cavity. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 170 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. Mrs. Sing is a 44-year-old patient who presents to the office with a complaint of enlarged
lymph nodes. When enlarged, which lymph nodes are most likely to be a sign of pathology (e.g., malignancy)? a. Occipital b. Anterior cervical c. Supraclavicular d. Femoral ANS: C
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy, even in children; an enlarged supraclavicular lymph node may be the sentinel node of Hodgkin disease. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 171 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Lymphoid tissue normally regresses to adult size by: a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. ANS: D
The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 170 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. A congenital defect in the immune system of a 2-week-old infant may be suspected if: a. there are small femoral nodes palpable. b. the umbilical cord has not yet dropped off. c. the tonsils are visible. d. the thymus is visible on a chest radiograph. ANS: B
In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 170 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. As adults age, their ability to resist infection is reduced because of the lymphatic nodes
becoming more: a. fibrotic. b. mucoid. c. porous. d. profuse. ANS: A
Older adults’ lymph nodes diminish in both number and size and are replaced with more fibrotic and fatty tissues.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 171 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Ms. Hartzel is a 33-year-old patient who presents to the office with complaints of enlarged
lymph nodes in her neck. During your examination, which part of the hand is used to assess lymph node size? a. Pads of the fingers b. Tips of the fingers c. Palm d. Ulnar surface ANS: A
The pads of the fingers are more sensitive and better for palpation than the fingertips and the palm; the ulnar surfaces of the hand and fingers are more sensitive for distinguishing vibration. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 172 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Which risk factor is least likely to result in someone contracting HIV infection? a. Multiple sexual contacts b. Hemophilia c. Intravenous drug use d. Working with AIDS patients ANS: D
Providing health care is considered rare as a work-related risk for HIV infection is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and IV drug use carry a higher rate of transmission of HIV. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 172 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Equipment for examining the lymphatic system includes a: a. caliper. b. centimeter ruler. c. goniometer. d. syringe and needle. ANS: B
The centimeter ruler and marking pencil are the only equipment needed for examination of the lymphatic system. They are used to measure and outline the borders of the nodes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 172 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender
ANS: D
Tenderness is almost always indicative of inflammation. Shotty nodes (feel like the tip of an eraser) that are fixed are of greater concern. Shotty, movable, or fixed nodes are not usually associated with inflammation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 173 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Mr. Walker is a 21-year-old man who complains of a sore throat. On examination, you note
red, swollen tonsils. The lymph nodes located nearest the palatine tonsils are the ________ nodes. a. supraclavicular b. retropharyngeal c. submental d. submandibular ANS: B
The retropharyngeal (tonsillar) nodes and parotid nodes lie at the angle of the mandible. The submental and submandibular nodes lie more distal to the mandible, and the supraclavicular nodes lie superior to the clavicle. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 174 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Mr. McDonnel is a 29-year-old patient who presents to the office with complaints of enlarged
lymph nodes just inferior to the chin. Nodes that are palpable just inferior to the chin are the ______________ nodes. a. infraclavicular b. submental c. submandibular d. parotid ANS: B
Nodes just inferior to the chin and distal from the mandible are the submental nodes. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 175 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Nodes located nearest the elbow are the ____________ nodes. a. supraclavicular b. axillary c. epitrochlear d. popliteal ANS: C
Nodes nearest the elbow are the epitrochlear, nearest the clavicle are the supraclavicular, nearest the knee are the popliteal, and nearest the armpit are the axillary nodes. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 175-176 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
19. Which landmark is the dividing line between the anterior and posterior cervical triangles? a. Clavicle b. Cervical spine c. Sternocleidomastoid d. Sternum ANS: C
The sternocleidomastoid is the landmark dividing the anterior and posterior cervical triangles. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 174 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Which nodes are also called Virchow nodes? a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular ANS: D
The supraclavicular nodes are also referred to as Virchow nodes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 173 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. The harder and more discrete a node, the more likely that there is a(n): a. innocent cause. b. infection. c. malignancy. d. metabolic disease. ANS: C
Tender nodes almost always indicate the presence of an infection, whereas a hard, discrete, and nontender node is more likely to represent a malignancy. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 173 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which of the following findings indicates that the examiner is assessing a blood vessel rather
than a lymph node? a. A bruit b. Inflammation c. Tenderness d. Redness ANS: A
Pulsations and auscultation of bruits indicate a blood vessel and not a lymph node. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 173 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Transillumination is performed during an examination of the lymphatic system to: a. detect lymphatic pulsation.
b. distinguish nodes from cysts. c. evaluate nodal contours. d. observe erythematous lesions. ANS: B
Larger nodal masses should be transilluminated to determine whether the mass is actually a cyst rather than a node. DIF: Cognitive Level: Applying (Application) REF: p. 173 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Nodes located at the base of the skull are the ____________ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear ANS: C
The occipital nodes are located at the base of the skull. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 174 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Nodes located over the mastoid process are the ____________ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear ANS: B
Nodes located superficially over the mastoid process are the postauricular nodes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 174 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When examining lymph nodes near a joint in the arm or leg, which of the following
maneuvers is likely to facilitate the examination? a. Extension of the extremity b. Circumduction of the extremity c. Flexion of the extremity d. Rotation of the extremity ANS: C
Bending joint areas will ease taut tissues and allow for better accessibility to palpation. DIF: Cognitive Level: Applying (Application) REF: p. 176 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Mrs. Black is a 49-year-old patient who presents to the office with complaints of fatigue and
joint pain. When examining the epitrochlear nodes, which joint should be supported? a. Elbow b. Knee
c. Shoulder d. Wrist ANS: A
To palpate the epitrochlear nodes, you should support the elbow with one hand while you explore with the other hand. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 176 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. To palpate the inguinal nodes, you should have the patient: a. bend over a table and cough. b. lie supine with knees slightly flexed. c. lie supine with legs extended. d. stand and cough vigorously. ANS: B
To palpate the inguinal nodes, you should have the patient lie supine and slightly flex her or his knees. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 176 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. It is not unusual to find enlarged postauricular and occipital nodes in: a. children younger than 2 years. b. school-age children. c. adolescents. d. adults. ANS: A
Children younger than 2 years often have enlarged postauricular and occipital nodes. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 170-171 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Large palatine tonsils are common in: a. children. b. adolescents. c. young adults. d. older adults. ANS: A
The palatine tonsils are larger in early childhood and not necessarily an indication of infection. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 170 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be
associated with excessively enlarged: a. branchial cleft cysts. b. cystic hygromas.
c. palatine tonsils. d. thyroglossal duct cysts. ANS: C
Palatine tonsil enlargement, grades 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck. DIF: Cognitive Level: Applying (Application) REF: p. 177 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. The most important clue to the diagnosis of immunodeficiency disease in a child is: a. family history. b. illness in siblings. c. previous hospitalizations. d. serious recurring infections. ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon infections, such as Pneumocystis jirovecii, or other fungal infections that do not respond as expected to therapy. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 177 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. A red streak that follows the course of the lymphatic collecting duct is a finding associated
with: a. Hodgkin disease. b. lymphangitis. c. lymphedema. d. lymphoma. ANS: B
Lymphangitis—inflammation of the lymphatic vessels—is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin disease and lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 172 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. To find the infection site associated with acute lymphangitis, the examiner should look
________ to the inflammation. a. proximal b. distal c. contralateral d. anterior ANS: B
The examiner should look distal to the inflammation to find the site of infection associated with acute lymphangitis. The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 178 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. The most common causes of acute suppurative lymphadenitis are: a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex types 1 and 2. d. streptococcal and staphylococcal organisms. ANS: D
Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the organisms usually responsible for suppurative (pus-forming) lymphadenitis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 178 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Which disorder is characterized by a single node that is chronically enlarged and nontender in
a patient with no other symptoms? a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis ANS: D
Toxoplasmosis is characterized by a chronically enlarged, nontender, single node—usually in the posterior cervical chain. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 181 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. Initial signs and symptoms of Epstein-Barr virus mononucleosis usually include: a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. ANS: A
Presenting signs and symptoms of Epstein-Barr virus mononucleosis are pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly and/or rash. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 181 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Enlarged inguinal nodes are likely to be associated with: a. genital herpes. b. pelvic inflammatory disease. c. uterine cancer. d. testicular cancer.
ANS: A
Uterine and testicular cancers are not inflammatory processes and not likely to cause enlarged inguinal nodes. The female genitalia drain into the pelvis and the testes drain into the abdomen, where they are not accessible to inspection and palpation. Lesions to the vulva and penile and scrotal areas cause inguinal nodal enlargement. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 176 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Tender nodes associated with cat scratch disease are usually found in which area? a. Epitrochlear area b. Popliteal area c. Axilla d. Inguinal area ANS: C
Cat scratch disease usually results in enlargement of nodes in the head, neck, and axillae. Although epitrochlear enlargement occurs most exclusively in cat scratch fever, its occurrence is less common. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 182 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Which disorder is a dysfunction of cell-mediated immunity? a. Acute idiopathic polyneuritis b. Acquired immunodeficiency syndrome c. Epstein-Barr virus (EBV) mononucleosis d. Systemic lupus erythematosus (SLE) ANS: B
Acquired immunodeficiency syndrome is characterized by a dysfunction of cell-mediated immunity (e.g., T lymphocytes). EBV is a viral infection, SLE is an autoimmune disorder, and acute idiopathic polyneuritis (Guillain-Barré) is an immune disorder affecting the myelin sheaths. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 182 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Serum sickness is usually characterized first by the appearance of: a. lymph node enlargement. b. joint pain. c. urticaria. d. fever. ANS: C
Urticaria is the first sign of serum sickness, followed by lymphadenopathy, joint pain, fever, and facial edema. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 182 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
42. What is the most frequent cause of edema of the lower extremities? a. Deficiency of vitamins and minerals b. Excessive walking or running c. Prolonged sitting or standing d. Use of table salt ANS: C
The most common cause of edema in the lower extremities is decreased venous return. Prolonged sitting or standing results in stasis, which increases orthostatic pressure in the legs and results in edema. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 178-179 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. The nurse tells her patient with lymphadenopathy not to rub the swollen lymph node because
this would result in: a. spreading the infection. b. enlarging the node. c. slowing the lymphatic drainage. d. making the node more fibrotic. ANS: B
Increased body or metabolic activity and massage cause increased lymph fluid volume and swelling of the node. DIF: Cognitive Level: Applying (Application) REF: p. 169 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following conditions will stimulate lymph node enlargement? (Select all that
apply.) a. Graves disease b. Lymphangioma c. Esophageal reflux d. Parotid swelling ANS: A, B, D DIF: Cognitive Level: Applying (Application) REF: p. 180 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Normal lymph is composed primarily of _________________. ANS:
white blood cells Lymph fluid is mostly composed of a variety of lymphocytes, minimal red blood cells, no platelets, and some antigens/antibodies according to its immune function.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 167 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Hodgkin disease is most common in ______________________. ANS:
late adolescence and young adulthood Hodgkin disease occurs in the young of all races and in males more than in females. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 180 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 10: Head and Neck Test Bank—Nursing MULTIPLE CHOICE 1. Which cranial nerves innervate the face? a. II and V b. III and VI c. V and VII d. VIII and IX ANS: C
Facial nerves are controlled by cranial nerves V and VII; cranial nerves II, III, and VI control the eyes, cranial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The parotid, submandibular, and sublingual salivary glands: a. impair carbohydrate digestion. b. inhibit dental caries. c. lubricate nasal surfaces. d. promote dry mouth. ANS: B
These glands function together to secrete saliva, which moistens the mouth, aids in carbohydrate breakdown, and prevents cavities. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that
he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note that the greatest degree of cervical mobility is at: a. C1 to C2. b. C2 to C3. c. C3 to C4. d. C4 to C5. ANS: D
C4 to C5 and C5 to C6 are the cervical vertebrae with the greatest movement. The types of movement includes flexion, extension, and hyperflexion, as well as horizontal movements of lateral flexion and rotation. DIF: Cognitive Level: Applying (Application) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of
the tracheal cartilage is at the: a. cricoid. b. hyoid.
c. thyroid. d. sternocleidomastoid. ANS: A
The walls of the trachea are supported by nine cartilages. The cricoid cartilage is the most superior cartilage and is ring-shaped. The hyoid bone sits just below the mandible, the thyroid gland is not a part of this region but rather lies across, and the sternocleidomastoid muscles are on the lateral side of the neck. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly
into adolescence. Which structures disproportionately enlarge in the male during adolescence? a. Coronal sutures b. Hyoid and cricoid cartilages c. Mandible and maxilla bones d. Nose and thyroid cartilages ANS: D
In adolescent males, the nose enlarges and the thyroid cartilage becomes the largest component of the anterior larynx, known as the Adam’s apple. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 186 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Spaces between the cranial bones accommodate: a. brain growth. b. cartilage formation. c. muscular expansion. d. nerve regeneration. ANS: A
The suture lines, the spaces between the cranial bones, allow for brain growth and later fuse after growth is complete. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 186 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. When examining the skull of a 4-month-old baby, you should normally find: a. closure of the anterior fontanel. b. closure of the posterior fontanel. c. ossification of all sutures. d. overlap of cranial bones. ANS: B
At 2 months of age, the posterior fontanel should be closed or ossified with the anterior fontanel, a larger fontanel, closing at 24 months. The only time the cranial bones should overlap is at a vaginal birth as a result of pressure within the birth canal. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 186 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. The brown or tan pigmentation on the forehead, nose, and malar prominence of some
pregnant women is called: a. hormonal acne. b. erythema. c. alopecia. d. chloasma. ANS: D
Chloasma—brown-tan facial pigmentation during pregnancy—will fade after delivery. Hormonal acne and erythema do not result in brown or tan pigmentation, and alopecia is loss of hair. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 197 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Which of the following is an expected change in the assessment of the thyroid during
pregnancy? a. Palpation of the gland becomes difficult. b. A bruit is auscultated. c. Inspection reveals a goiter. d. The gland is tender on palpation. ANS: B
During pregnancy, the thyroid gland hypertrophies (not to the point of a goiter), palpation is easier and, because the gland also has increased vascularity, bruits are common. It is an abnormal finding for the thyroid to feel fibrotic, tender, or smaller. DIF: Cognitive Level: Applying (Application) REF: p. 197 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On
examination, you noted a bruit heard over the thyroid. This is suggestive of: a. hypothyroidism. b. hyperthyroidism. c. thyroid cancer. d. thyroid cyst. ANS: B
Because of hypermetabolic states such as hyperthyroidism, a bruit may be heard as a result of the increased blood flow to the area. Auscultating a bruit is not symptomatic of hypothyroidism, cancer, or a cyst. A nodule is more indicative of cancer. DIF: Cognitive Level: Applying (Application) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Ms. Galvan is a 22-year-old secretary who comes to the clinic with headaches of 6 weeks’
duration. She tells the office assistant about her heavy schedule, including part-time work and evening classes. Her vital signs are normal. Which information is most appropriate to Ms. Galvan’s history? a. Current medications b. Elimination patterns
c. Immunization status d. Previous pregnancies ANS: A
Some current medications, such as birth control pills, nitroglycerin, antihypertensives, antiseizure drugs, and some diabetic drugs, can be headache triggers. Withdrawal of headache medication can also trigger headaches. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 188 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Observation during history taking is the best way to examine for: a. head position. b. scalp lice. c. thyroid size. d. tracheal alignment. ANS: A
Head position as well as facial features are best observed when talking to the patient during the history. Scalp lice, thyroid size, and tracheal alignment are best assessed by palpation and closer physical observation. DIF: Cognitive Level: Applying (Application) REF: p. 189 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. During a head and neck assessment of a neonate, it is important to screen for: a. the presence of torticollis. b. signs and symptoms of cerebral palsy. c. uneven movement of the eyes. d. unilateral movement of the tongue. ANS: A
Torticollis is usually caused by constraint of the newborn in utero or injury during vaginal delivery. The other symptoms may be difficult to discern because of the infant’s lack of fine motor skills and control of voluntary muscle groups. During a head and neck assessment of a neonate, it is not important to screen for signs and symptoms of cerebral palsy, uneven movement of the eyes, or unilateral movement of the tongue. DIF: Cognitive Level: Applying (Application) REF: p. 195 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. To detect bruits in the head and neck region, you should place the bell of the stethoscope: a. above the temporal and sagittal regions. b. below the eyes and on the coronal suture. c. near the zygomatic and nasal areas. d. on the temporal region and below the occiput. ANS: D
Vascular abnormalities of the head and neck may cause audible bruits and are best heard over the eyes, in the temporal area, and below the occiput. These are all areas of major blood supply to the head.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 192 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. During a physical examination of a 30-year-old Chinese man, you notice a slight asymmetry
of his face. The cranial nerve examination is normal. Your best action is to: a. ask the patient if this characteristic runs in his family. b. perform monofilament testing on the face. c. consult with the physician regarding the laboratory tests needed. d. record the finding in the patient’s chart. ANS: D
It is not abnormal to have some slight asymmetry of the face that does not require further questioning, tests, or unnecessary laboratory work, but it does require a notation in the chart that could be referenced for future concerns. DIF: Cognitive Level: Applying (Application) REF: p. 189 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. A bruit, or blowing sound, over the skull or temporal region of an adult indicates a: a. degenerative change. b. hyperthyroid storm. c. skull fracture. d. vascular anomaly. ANS: D
Temporal bruits can indicate a vascular anomaly such as an arterial obstruction, aneurysm, or vascular neoplasm. Audible bruits are not associated with degenerative changes or skull fracture. Hyperthyroid storm would cause tachycardia and palpations but not usually a bruit. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 192 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Spasmodic muscular contractions of the head, face, or neck are called: a. torticollis. b. tics. c. dimpling. d. webbing. ANS: B
Tics, by definition, are spasmodic, repetitive contractions of the muscles of the face, head, or neck. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 189 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Coarse, dry, and brittle hair is associated with which metabolic disorder? a. Hypothyroidism b. Diabetes mellitus c. Addison disease d. Cushing syndrome ANS: A
Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 192 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. An inconsequential finding on the head of an adult is a palpable: a. embryonic remnant. b. posterior fontanel. c. sagittal suture ridge. d. skull indentation. ANS: C
The sites of fusion on the skull are not generally palpable after 6 months of age; however, if the sagittal suture line is felt in an adult, it is not significant. An embryonic remnant is associated with branchial cleft cyst, not the head. The posterior fontanel should not be palpable after fusion. A skull indentation may indicate a skull fracture. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 192 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Which is the best way to position a patient’s neck for palpation of the thyroid? a. Flexed away from the side being examined b. Flexed directly forward c. Flexed toward the side being examined d. Hyperextended directly backward ANS: C
The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward and laterally toward the side being examined. DIF: Cognitive Level: Applying (Application) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. A stethoscope is used in a head and neck examination to assess: a. intracranial fluid. b. pulsating fontanels. c. skull bone development. d. thyroid vascular sounds. ANS: D
Although the skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Tracheal tug suggests the presence of a(n): a. enlarged thyroid. b. swallowing disorder. c. aortic aneurysm.
d. thoracic carcinoma. ANS: C
When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensation in sync with the pulse of the patient. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 193 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. The thyroid gland should: a. be slightly left of midline. b. have a clear vascular sound. c. move when the patient swallows. d. tug with each heartbeat. ANS: C
It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate a nodular growth or enlargement. The thyroid gland should not be slightly left of midline. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a tug with each heartbeat is a sign of an aortic aneurysm. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The
right lobe is 25% larger than the left. These data would indicate: a. a congenital anomaly. b. a multinodular goiter. c. a normal thyroid gland. d. thyroiditis. ANS: C
The situation described is most likely a normal finding; the right lobe of the thyroid gland is typically 25% larger than the left and measures 4 cm. The other choices produce enlargements beyond these normal findings. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. The correct way to transilluminate an infant’s skull is to: a. hold the light 18 inches from the skull. b. move the light toward and then away from the head. c. place the light firmly against the skull. d. shine the light inside the infant’s mouth. ANS: C
The correct technique for transillumination of the infant’s skull is to place the light source tightly against the skull so that no light escapes. DIF: Cognitive Level: Applying (Application) REF: p. 196 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
26. The most common form of birth trauma of the scalp is: a. caput succedaneum. b. cephalohematoma. c. cranial bossing. d. torticollis. ANS: A
Caput succedaneum, as a result of birth trauma, results in swelling of the scalp. The swelling can cross the suture lines. A cephalohematoma is a hematoma under the skull, and cranial bossing is compensatory growth of the skull related to craniosynostosis. Torticollis involves the neck. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Which of the following is true regarding caput succedaneum? a. It is a subperiosteal collection of blood. b. It is firm and its edges are well defined. c. It develops several days after delivery. d. It is seen over the presenting part of the head. ANS: D
Caput succedaneum is seen over the presenting part of the head during delivery as the skull passes through the pelvis; the scalp usually feels edematous to touch, which fades after a few days. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 194 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Which of the following is true regarding a cephalohematoma? a. It is bound by suture lines. b. The affected part feels soft. c. It is obvious at birth. d. The margins are poorly defined. ANS: A
The condition is subperiosteal, under the bone, and contained by the margins of the suture lines; it does not cross the suture line. It is often unnoticed at birth and typically feels firm, with its edges well defined. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 195 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Nuchal rigidity is most commonly associated with: a. thyroiditis. b. meningeal irritation. c. Down syndrome. d. cranial nerve V damage. ANS: B
Stiffness and inability to flex the neck, or nuchal rigidity, constitute a classic symptom of meningeal irritation.
DIF: Cognitive Level: Applying (Application) REF: p. 193 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. When noting a bulging fontanel with marked pulsations in a 6-month-old, you suspect: a. normal development. b. congenital anomaly. c. increased intracranial pressure. d. fever response to a viral infection. ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel feels slightly depressed, with mild pulsations. DIF: Cognitive Level: Applying (Application) REF: p. 195 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Which type of headache usually occurs at night, is precipitated by alcohol consumption, and
occurs more often in men than in women? a. Classic migraine b. Temporal arteritis c. Cluster d. Hypertensive ANS: C
Cluster headaches usually occur at night; they are associated with alcohol consumption and occur more often in men. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 198 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. A 29-year-old woman presents to the urgent care center with a history of a severe headache of
2 hours’ duration. She describes it as bandlike and constricting. In interviewing the woman about her complaint, you would ask: a. whether she has experienced increased tearfulness. b. the date of her last menstrual period. c. whether these headaches started in childhood. d. whether she is particularly stressed or overworked. ANS: D
This woman is describing a tension headache, which feels bandlike and constricting. Tension headaches are associated with stress, so you should inquire about her stress level. Increased tearfulness is common with cluster headaches, and migraines are associated with menstrual periods. You would not need to ask whether these headaches started in childhood. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 198 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck
region, at the base of the tongue. This is most likely a: a. parotid gland tumor. b. branchial cleft cyst.
c. Stensen duct stone. d. thyroglossal duct cyst. ANS: D
A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. A parotid gland tumor occurs in the ear and cheek bone area. A branchial cleft cyst occurs in the lateral neck area. A Stensen duct stone occurs in the parotid duct. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 195 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. Moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are
characteristics associated with: a. Cushing syndrome. b. Graves disease. c. myxedema. d. systemic lupus erythematosus. ANS: B
Skin problems, along with changes in hair, protruding eyes, and a glazed look, are symptoms associated with Graves disease or hyperthyroidism. Myxedema is a condition of hypothyroidism. Cushing syndrome is characterized by plump skin around the face, and lupus usually presents with a rash around the face. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 202 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. You are examining Ms. L, age 78 years. You find a sunken appearance of her eyes, cheeks,
and temporal areas. Her skin is dry, and her nose appears sharp. This description of Ms. L’s facies is associated with: a. cutis laxa syndrome. b. Hurler syndrome. c. old age. d. terminal illness. ANS: D
In the late stages of terminal illness, the face may appear sunken, facial bones will be more visible, and the skin will be dry. This is referred to as hippocratic facies. Cutis laxa syndrome is a rare condition in which the skin loses its elasticity and sags all over. Hurler syndrome is marked by an enlarged skull and short neck. The description of Ms. L’s facies is not a common finding of old age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 189 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Which of the following findings would be consistent with fetal alcohol syndrome (FAS)? a. Corneal clouding b. Eye slanting c. Mild ptosis d. Symmetric, bulging fontanels ANS: C
With FAS, classic findings include poorly formed or flat philtrum, widespread eyes with inner epicanthal folds and mild ptosis, hirsute forehead, short nose, relatively thin upper lip, and small eye openings. Corneal clouding is seen with Hurler syndrome, eye slanting is seen in Down syndrome, and bulging fontanels are seen in hydrocephalus. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 191 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. What structure is located in the upper third of the sternocleidomastoid muscle? a. Branchial cleft cyst b. Cricoid cartilage c. Lacrimal duct d. Thyroid gland ANS: A
The branchial cleft cyst is a remnant of development during the embryologic stage and is located around the upper third of the sternocleidomastoid muscle. Cricoid cartilage is located at the trachea, below the epiglottis. The lacrimal duct is where tears drain. The thyroid gland is located at the anterior part of the neck. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 195-196 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Which of the following is a chronic autoimmune disorder? a. Microcephaly b. Hashimoto disease c. Salivary gland tumor d. Down syndrome ANS: B
Hashimoto disease is a chronic autoimmune thyroid disease that commonly affects children and women 30 to 50 years of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 202 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. The premature union of cranial sutures that involves the shape of the head without mental
retardation is: a. craniosynostosis. b. encephalocele. c. microcephaly. d. myxedema. ANS: A
In patients with craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but mental retardation is not involved. Encephalocele and microcephaly involve mental retardation. Myxedema is a condition of hyperthyroidism. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 203 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
40. Mr. Donaldson is a 64-year-old patient with complaints of headaches. As the examiner, you
are palpating his head during your physical examination. Which of the following would be your first step? a. Palpate the patient’s hair, noting texture, color, and distribution. b. Palpate the temporomandibular joint. c. Palpate the skull from front to back. d. Palpate the temporal artery. ANS: C
Palpate the skull in a gentle rotary movement first, progressing systematically from front to back. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 192 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the
_________ triangle. ANS:
posterior Anatomically, the trapezius, sternocleidomastoid muscles and clavicle comprise what is referred to as the posterior triangle, which includes the posterior cervical lymph nodes. The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The medial borders of the sternocleidomastoid muscles and the mandible form the _________
triangle. ANS:
anterior The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles, and clavicle form the posterior triangle. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The largest endocrine gland in the body lies in the _________ triangle. ANS:
anterior
The thyroid gland is the largest endocrine gland and lies within the anterior triangle. The posterior triangle contains cervical lymph nodes, and the lateral and medial triangles are not anatomic landmarks. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 185 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiological Adaptation 4. Closure of the anterior skull fontanel should occur by ______________. ANS:
24 months of age The anterior fontanel can remain palpable until 24 months, at which time it closes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 186 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 11: Eyes Test Bank—Nursing MULTIPLE CHOICE 1. Contraction of which eye structure controls the amount of light that reaches the retina? a. Retina b. Iris c. Sclera d. Lens ANS: B
The iris is able to dilate and contract, allowing light to reach the retina. The retina is deep within the eye and does not control the amount of entering light. The sclera is not able to dilate and contract. The lens is merely a transparent disc that acts as a focus for the retina. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Contraction or relaxation of the ciliary body: a. allows voluntary blinking. b. changes lens thickness. c. regulates peripheral vision. d. sends light impulses to the brain. ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body; contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The sensory network of the eye is the: a. cornea. b. iris. c. pupil. d. retina. ANS: D
The retina acts as the sensory network of the eye in that it sends electric impulses to the brain that are transformed from light. The cornea, iris, and pupil act together as an opening for light to pass through the lens. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Retinal hemorrhages in an infant require investigation for: a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor.
d. child abuse. ANS: D
Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. DIF: Cognitive Level: Applying (Application) REF: p. 230 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood c. Infancy d. Pregnancy ANS: D
Because of rising hormone levels, an increased amount of lysozyme is present in tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Tears flow over the cornea and drain via the lacrimal sac into the: a. anterior fossa. b. posterior pharynx. c. nasal meatus. d. thyroglossal duct. ANS: C
Anatomically, the eye is closest to the nose, so tears drain from the lacrimal sac into the nasal lacrimal duct. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 205 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Mrs. Alden is a 29-year-old pregnant patient in her third trimester. She tells you that her vision
has been a little blurred, and she thinks she needs to get new contact lenses. You should advise her to: a. get new lenses as soon as possible to avoid complications. b. wait until several weeks after delivery to get new lenses. c. go to the nearest emergency department for evaluation. d. change her diet to include more yellow vegetables. ANS: B
Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur but will subside several weeks after pregnancy. The blurred vision is a normal occurrence during pregnancy. It is not an emergency, nor is it diet-dependent. DIF: Cognitive Level: Applying (Application) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. Which of the following is a relatively benign condition that may occur during pregnancy or
labor? a. Macular degeneration b. Papilledema c. Subconjunctival hemorrhage d. Cupping of the optic disc ANS: C
Because of falling intraocular pressure during late stages of pregnancy, subconjunctival hemorrhages may occur and resolve spontaneously. Macular degeneration and cupping of the optic disc occur in older adults. Papilledema is never a benign condition. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 211 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. When does the lens usually become more rigid while the ciliary muscle of the iris becomes
weaker? a. At 25 years of age b. Around 35 years of age c. Around 45 years of age d. After 65 years of age ANS: C
Starting at around 45 years of age, the lens starts to change and become more rigid, and the ciliary muscle begins to weaken. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. A condition that typically develops by the age of 45 years is: a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. ANS: A
By 45 years of age, a condition known as presbyopia develops; presbyopia involves a weakening of accommodation. Hyperopia occurs in early infancy. Myopia and astigmatism can occur at any time. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Which of the following findings, when seen in the infant, is ominous? a. Difficulty tracking objects with the eyes b. Appearing to have better peripheral than central vision c. Blinking when bright light is directed at the face d. White pupils on photographs ANS: D
The absence of a red reflex, determined by physical examination or the appearance of white pupils on a photograph, is indicative of retinoblastoma, a serious retinal tumor.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 208 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. The Rosenbaum card is used to measure: a. distance perception. b. near vision. c. peripheral distortion. d. the ability to identify colors. ANS: B
The Rosenbaum card is best used to measure nearsightedness because the patient holds the card at a comfortable distance and reads from the card. The Rosenbaum card is not used to measure distance perception because distance perception cannot be accurately measured with a card held close to the patient. Peripheral vision is assessed by an examiner with hand movements. Color identification can be measured with color cards. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 209 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. When measuring visual acuity, you are assessing cranial nerve: a. I. b. II. c. IV. d. VI. ANS: B
Visual acuity is controlled by cranial nerve II. Cranial nerve I deals with the sense of smell. Cranial nerve IV deals with accommodation. Cranial nerve VI deals with lateral eye muscle movements. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 208 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Measurement of near vision should be done: a. in each eye separately. b. with the head at a 45-degree angle. c. with the use of primary colors. d. with the use of the Snellen chart. ANS: A
Near vision is measured with the Rosenbaum card and should be tested in each eye separately, with the patient holding the card in front of her or him at about 35 cm. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 209 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Mr. C’s visual acuity is 20/50. This means that he: a. can see 50% of what the average person sees at 20 feet. b. has perfect vision when tested at 50 feet. c. can see 20% of the letters on the chart’s 20/50 line. d. can read letters while standing 20 feet from the chart that the average person could
read at 50 feet. ANS: D
Visual acuity is measured as a fraction, in which the top number is the distance that the patient is standing from the chart; the bottom number is the distance that an average person can stand and still read the line. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 209 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Peripheral vision can be estimated by means of which test? a. Confrontation b. Pupillary reaction c. Accommodation d. Snellen E chart ANS: A
The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done to observe the pupil’s response to light. The accommodation test deals with the pupils’ reaction to light. The Snellen E chart is used to measure visual acuity. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 209 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. The criterion for determining the adequacy of a patient’s visual field is: a. the ability to discriminate primary colors. b. the ability to discriminate details. c. correspondence with the visual field of the examiner. d. distance vision equal to that of an average person. ANS: C
The examiner compares his or her own peripheral vision to that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 209 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Periorbital edema is: a. a sign of abnormality. b. expected with aging. c. more common in males. d. present in children. ANS: A
A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise. DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 210
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
19. Xanthelasma may suggest that the patient has an abnormality of: a. lipid metabolism. b. cognitive function. c. renal metabolism. d. bone marrow function. ANS: A
Small, odd-shaped, yellow-colored plaques around the eyes—called xanthelasma—are actually lipid deposits and are characteristic of a lipid metabolism problem. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her
eyes, you note that the left upper eyelid droops, covering more of the iris than does the right. This is recorded as: a. exophthalmos on the right. b. ptosis on the left. c. nystagmus on the left. d. astigmatism on the right. ANS: B
Ptosis is when one of the upper eyelids covers more of the iris than the other lid, possibly extending over the pupil. DIF: Cognitive Level: Applying (Application) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Ptosis may be secondary to: a. paresis of a branch of cranial nerve III. b. hyperthyroidism. c. psoriasis. d. blepharitis. ANS: A
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos. Psoriasis is a skin condition. Blepharitis is inflammation of the eyelid. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. What is the name of the condition in which the eyelid is turned away, or everted, from the
globe? a. Ectropion b. Entropion c. Exophthalmos d. Ptosis ANS: A
Ectropion describes an everted lower lid that is turned away from the eye. Entropion describes the lower lid turning inward. Exophthalmos describes the bulging of the eye globe. Ptosis refers to a drooping of the upper eyelid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Entropion implies that the lower eyelid is: a. drooping. b. everted. c. edematous. d. turned inward. ANS: D
Entropion involves a slight inward turn of the lower eyelid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. A condition in which the eyelids do not completely meet to cover the globe is called: a. glaucoma. b. lagophthalmos. c. exophthalmos. d. hordeolum. ANS: B
Lagophthalmos is a term used to describe the condition in which eyelids do not completely meet when closing. Glaucoma involves elevated pressure in the eye. Exophthalmus involves bulging eyes. A hordeolum is better known as a stye. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Inspection of the tarsal conjunctiva should be performed: a. with every eye examination. b. in eye examinations in patients older than 45 years. c. when a foreign body may be present. d. for the patient with glaucoma. ANS: C
Inspecting the tarsal conjunctiva involves pulling the top eyelid down and up while everting the lid. This maneuver is reserved for inspecting for the presence of a foreign body. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 210 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. Mr. Morris is a 38-year-old patient who presents to the clinic with complaints of allergies. An
allergy can cause the conjunctiva to have a: a. cobblestone pattern. b. dry surface. c. subconjunctival hemorrhage. d. rust-colored pigment.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 211 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. An abnormal growth of conjunctiva extending over the cornea from the limbus is known as: a. a cataract. b. erythematous. c. glaucoma. d. a pterygium. ANS: D
An abnormal growth of the conjunctiva that extends over the cornea is called a pterygium. Cataracts and glaucoma do not affect the conjunctiva. Erythematous means that the area is red and irritated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 212 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. A pterygium is more common in people heavily exposed to: a. high altitudes. b. tuberculosis. c. ultraviolet light. d. cigarette smoke. ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to the development of a pterygium. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 212 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Mr. Brown was admitted from the emergency department, and you are completing his
physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been: a. in a coma. b. taking sympathomimetic drugs (cocaine). c. taking opioid drugs (morphine). d. treated for head trauma. ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or the use of drops for glaucoma. Pupils are usually dilated greater than 6 mm in a patient described in the other choices. DIF: Cognitive Level: Applying (Application) REF: p. 213 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
30. When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient
to respond by: a. brisk blinking. b. copious tearing. c. pupil dilation. d. reflex smiling. ANS: A
Brisk blinking is an expected response to corneal sensitivity testing, which involves gently touching the cornea with a piece of cotton. DIF: Cognitive Level: Applying (Application) REF: p. 212 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. You observe pupillary response as the patient looks at a distant object and then at an object
held 10 cm from the bridge of the nose. You are assessing for: a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then to look at another, much closer object (pupils constrict). DIF: Cognitive Level: Applying (Application) REF: p. 213 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. Mydriasis is an accompaniment of: a. coma. b. diabetes. c. hyperopia. d. astigmatism. ANS: A
Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma, but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 213 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. The inequality of pupillary size is called: a. mydriasis. b. diopter c. ptosis. d. anisocoria. ANS: D
Anisocoria is when the pupil size is not the same but the reflexes remain normal. Mydriasis is when pupil size is large and even. Diopter is a unit of measurement used to focus a lens. Ptosis is a droopy eyelid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 213 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. When inspecting the region of the lacrimal gland, palpate: a. the lower orbital rim, near the inner canthus. b. in the area between the arch of the eyebrow and upper lid. c. beneath the lower lid, adjacent to the inner canthus. d. adjacent to the lateral aspect of the eye, just beneath the upper lid. ANS: A
The lacrimal gland is located in the area between the arch of the eyebrow and upper lid. The lacrimal sac is located in the corner of the eye closest to the nose, near the inner canthus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 214 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Examination to assess for extraocular muscle imbalance is conducted by: a. comparing pupillary responses to different shapes. b. having the patient follow your finger through planes. c. inspecting slightly closed lids for fasciculations. d. transilluminating the cornea with tangential light. ANS: B
The test for extraocular muscle function is to have the patient follow an object as you move it through planes of vision while observing for nystagmus. DIF: Cognitive Level: Applying (Application) REF: p. 215 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Mr. Older is a 40-year-old patient who presents to the office for a follow-up eye examination
after the diagnosis of myopia. To see retinal details in a myopic patient, you will need to: a. adjust your ophthalmoscope into the plus lens. b. move your ophthalmoscope backward. c. move your hand farther forward. d. turn your ophthalmoscope to a minus lens. ANS: D
The myopic patient (nearsighted) has longer eyeballs, so that light rays focus in front of the retina. To see the retina, use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a hyperopic patient, use a plus lens. DIF: Cognitive Level: Applying (Application) REF: p. 216 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. The unit of measurement for describing lesion size and location on the fundus is the: a. disc diameter. b. macular diameter. c. pupillary diameter.
d. centimeter. ANS: A
When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and is therefore the unit of measurement used to describe lesion size and location on the fundus. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 217 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to
examine the: a. retina. b. optic disc. c. retinal vessels. d. macula. ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light. DIF: Cognitive Level: Applying (Application) REF: p. 218 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Opacities of the red reflex may indicate the presence of: a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in the newborn. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 225 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. If a patient has early papilledema, using an ophthalmoscope, the examiner will be able to
detect: a. dilated retinal veins. b. retinal vein pulsations. c. sharply defined optic discs. d. visual defects. ANS: A
Papilledema is caused by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. Retinal vein pulsations and visual defects are not visible with an ophthalmoscope. On examination, papilledema is characterized by loss of definition of the optic disc. DIF: Cognitive Level: Applying (Application)
REF: p. 219
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
41. Cupping of the optic disc may be a result of: a. migraine headaches. b. diabetes. c. glaucoma. d. dehydration ANS: C
Cupping is seen with causes of increased intraocular pressure, such as glaucoma. Migraine headaches, diabetes, and dehydration do not cause cupping of the optic disc. Diabetes results in cotton wool patches and hemorrhages. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 227 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. Drusen bodies are most commonly a consequence of: a. glaucoma. b. aging. c. presbyopia. d. papilledema. ANS: B
Drusen bodies, or lesions or spots on the retina, are part of the aging process. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 218 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. When drusen bodies are noted to be increasing in number or in intensity of color, the patient
should be further evaluated with a(n): a. Amsler grid. b. Snellen E chart. c. litmus test. d. confrontation test. ANS: A
Drusen bodies, when they increase in number or intensity of color, may indicate a precursor state of macular degeneration. When this happens, the patient’s central vision should be assessed using the Amsler grid. The Snellen chart measures visual acuity, the litmus test is used for testing pH, and a confrontation test examines peripheral vision. DIF: Cognitive Level: Applying (Application) REF: p. 218 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. Cotton wool spots are most closely associated with: a. glaucoma. b. normal aging processes. c. hypertension. d. eye trauma. ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes. DIF: Cognitive Level: Applying (Application) REF: p. 219 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. The Keith-Wagner-Barker system group IV is characterized by the development of: a. increased light reflex in the arterioles. b. crossing defects. c. cotton wool spots. d. papilledema. ANS: D
The Keith-Wagner-Barker system is used to classify changes to the eyes caused by hypertension. Group IV is the class that represents evidence of papilledema. An increased light reflex is in group I, crossing defects are in group II, and cotton wool spots are in group III. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 220 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. Which of the following may be suggestive of Down syndrome? a. Drusen bodies b. Papilledema c. Narrow palpebral fissures d. Prominent epicanthal folds ANS: D
Prominent epicanthal folds, or slanting of the eyes, may be normal in Asian infants, but in other ethnic groups it may indicate Down syndrome. DIF: Cognitive Level: Applying (Application) REF: p. 220 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. To differentiate between infants who have strabismus and those who have pseudostrabismus,
use the: a. confrontation test. b. corneal light reflex. c. E chart. d. Amsler grid. ANS: B
The corneal light reflex is used with infants to differentiate between strabismus and pseudostrabismus by noting an asymmetric versus symmetric light reflex. DIF: Cognitive Level: Applying (Application) REF: p. 221 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would
first: a. dim the room lights. b. elicit pain.
c. place him in the supine position. d. shine the penlight in his or her eyes. ANS: A
The best way to assess the eyes of a newborn is to start by dimming the lights because it encourages infants to open their eyes. DIF: Cognitive Level: Applying (Application) REF: p. 218 | 220 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. White specks scattered in a linear pattern around the entire circumference of the iris are
called: a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. ANS: D
Brushfield spots are characterized by white specks that align perfectly around the circumference of the iris and strongly suggest Down syndrome or mental retardation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 221 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. Bone spicule pigmentation is a hallmark of: a. chorioretinal pigmentosa. b. cytomegalovirus infection. c. lipemia retinalis. d. retinitis pigmentosa. ANS: D
Retinitis pigmentosa is inherited night blindness; it is characterized by the hallmark pigmentation of the peripheral fields or bone spicules. Chorioretinal pigmentosa and cytomegalovirus infection are not limited to night blindness, and lipemia retinalis is a result of an increase in triglyceride levels. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 227 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 51. Horner syndrome is manifested by: a. proptosis and contralateral mydriasis. b. excessive watering of the eyes. c. blurring of vision when glucose levels fall. d. ipsilateral miosis and mild ptosis. ANS: D
Horner syndrome is characterized by mild pupil constriction and drooping of the upper lid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis is manifested by enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 225
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
52. Dot hemorrhages, or microaneurysms, in the retina and the presence of hard and soft exudates
are most commonly seen in those with: a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. ANS: B
Dot hemorrhages or tiny aneurysms are characteristic of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 225 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 53. Which maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic
agents when examining a pregnant woman if the examination is mandatory? a. Have the woman keep her eyes closed for several minutes. b. Instill half the usual dosage. c. Keep the patient supine, with her head turned and flexed. d. Use nasolacrimal occlusion after instillation. ANS: D
To reduce absorption systemically, the examiner may use nasolacrimal occlusion after applying, which involves pinching the upper bridge of the nose. DIF: Cognitive Level: Applying (Application) REF: p. 222 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 54. Episcleritis may indicate: a. lipid abnormalities. b. an autoimmune disorder. c. an anaphylactoid reaction. d. severe anemia. ANS: B
Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with an autoimmune disorder. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 223 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 55. Changes seen in proliferative diabetic retinopathy are the result of: a. anoxic stimulation. b. macular damage. c. papilledema. d. minute hemorrhages. ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply from failing capillaries causes new vessel growth.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 226 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Mrs. Jones brings her infant son in for a routine physical examination. She asks you, as the
examiner, the age at which infants usually develop the ability to distinguish color. You explain that infants are first able to distinguish color at the age of ___ months. ANS:
6 By 6 months of age, vision has developed so that colors can be differentiated. At the age of 2 months, infants have not developed the ability to distinguish color. By the age of 12 months, infants already have the ability to distinguish color. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 207 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The most common cause of exophthalmos is _______________. ANS:
Graves disease Graves disease is the most common cause of exophthalmos, which is an increase in the eye tissue, resulting in the characteristic bulging eyes. However, if exophthalmos only involves one eye, the presence of a tumor should be suspected. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 223 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. When there is an imbalance found with the corneal light test, you should then perform the
______________ test. ANS:
cover-uncover If the corneal light reflex demonstrates an imbalance, the next test to perform is the coveruncover test. DIF: Cognitive Level: Applying (Application) REF: p. 215 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The Snellen E chart is appropriate for initial measurement of visual acuity in a child of age __
years. ANS:
3
For measurement of visual acuity with the Snellen chart to be accurate, the child must be cooperative; usually, by age 3 years, visual acuity can be assessed. DIF: Cognitive Level: Applying (Application) REF: p. 221 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Term infants have a visual acuity of about____/_____. ANS:
20; 400 Term infants are hyperopic, with a visual acuity of less than 20/400. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 206 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Signs and symptoms or infant retinoblastoma include which of the following: (Select all that
apply.) a. White reflex b. Red reflex c. Corneal light reflex d. Absence of a blink reflex e. Autosomal dominant trait f. Leukocoria g. Visual acuity of 20/500 ANS: A, E, F
Retinoblastoma in an infant is marked by a characteristic white reflex, also called cat’s eye reflex. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 229 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 12: Ears, Nose, and Throat Test Bank—Nursing MULTIPLE CHOICE 1. The middle ear contains the: a. cerumen and sebaceous glands. b. umbo and malleus. c. vestibule and cochlea. d. pars tensa and semicircular canals. ANS: B
The middle ear contains the ossicles, three small bones—the malleus (umbo is part of the malleus), the incus, and the stapes. Cerumen and sebaceous glands lie outside the middle ear. The vestibule and the cochlea lie in the inner ear. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa, and the semicircular canals lie in the inner ear. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The middle ear is normally filled with: a. air. b. blood. c. serous fluid. d. cerebrospinal fluid. ANS: A
The middle ear normally is an air-filled cavity in the temporal bone. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The hair cells of Corti and membrane of Corti: a. produce a waxy lubricant. b. protect the ear from foreign particles. c. stimulate the eighth cranial nerve. d. transmit vibrations to the ossicles. ANS: C
Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The organ of Corti is a coiled structure located inside the: a. cochlea in the inner ear. b. pars flaccida in the tympanic membrane. c. eustachian tube.
d. lateral aspect of the pinna. ANS: A
The cochlea is a coiled structure within the inner ear that contains the organ of Corti. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache.
In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning? a. Eustachian tube b. Inner ear c. Pars flaccida d. Triangular fossa ANS: A
The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using
recreational drugs. On examination, you have noted a septal perforation. Which of the following recreational drugs is commonly associated with nasal septum perforation? a. Heroin b. Cocaine c. PCP d. Ecstasy ANS: B
Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to perforation of the nasal septum. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 243 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus
tenderness, you should palpate over the: a. sphenoid and frontal sinuses. b. maxillary and frontal sinuses. c. maxillary sinuses only. d. sphenoid sinuses only. ANS: C
Only the maxillary and the frontal sinuses are accessible for physical examination; however, the young child does not develop frontal sinuses until 7 to 8 years of age. DIF: Cognitive Level: Applying (Application)
REF: p. 233
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
8. An infant’s auditory canal, compared with an adult’s, is: a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved forward. d. short and curved downward. ANS: B
Compared with the adult’s, the infant’s auditory canal is shorter and has an upward curve, which is why pulling the pinna down straightens the canal. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear
drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to: a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. ANS: A
The nurse should use the other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The eruption of permanent teeth usually begins with: a. upper central incisors. b. upper canines. c. lower central incisors. d. lower canines. ANS: C
The central incisors on the lower jaw usually erupt between 6 and 7 years of age as the first permanent teeth. Upper central incisors appear at 7 to 8 years of age. Upper canines appear at 11 to 12 years of age. Lower canines appear at 9 to 10 years of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with
health care information, you will explain that she can expect to experience: a. more nasal stuffiness. b. a sensitive sense of smell. c. drooling. d. enhanced hearing. ANS: A
Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. During which developmental stage are hoarseness, voice cracking, and a persistent cough
common findings in females? a. Adolescence b. Infancy c. Menopause d. Pregnancy ANS: D
Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and a persistent cough. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Hearing tends to decline after 50 years of age because of deterioration of: a. hair cells of the organ of Corti. b. the eustachian tube. c. the helix. d. cerumen. ANS: A
Hearing declines after 50 years of age because of degeneration of hair cells in the organ of Corti, as well as atrophy of the hair cells in the cochlea. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. You are performing hearing screening tests. Who would be expected to find difficulty in
hearing the highest frequencies? a. A 7-year-old b. An 18-year-old c. A 30-year-old d. A 50-year-old ANS: D
Sensorineural hearing loss begins after 50 years of age, initially with losses of high-frequency sounds and then progressing to tones of lower frequency. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about
current medications. Which medications, if listed, are likely to contribute to his hearing loss? a. Chlorothiazide b. Acetaminophen c. Salicylates
d. Cephalosporins ANS: C
Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Mr. Williams, age 25 years, has recovered recently from an upper and lower respiratory
infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history? a. Age-specific data b. Past medical data c. Past surgical data d. Social history ANS: B
Information concerning the patient’s chronic postnasal drip is part of the past medical history. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. A 6-month-old who can hear well can be expected to: a. exhibit the Moro reflex. b. stop breathing in response to sudden noise. c. turn his or her head toward the source of sound. d. imitate simple words. ANS: C
Six-month-old infants turn their head toward the source of sound; they start babbling, but they begin imitating speech sounds closer to 10 months of age. The Moro reflex and cessation of breathing in response to noise are lost by 3 months of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 250 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Which risk factor is associated with the highest rate of oral cancers? a. Women b. Being younger than 55 years c. excessive caffeine use d. Fanconi anemia ANS: D
Risk factors for oral cancer include age older than 55years, male gender, excessive alcohol use, dental lesions, tobacco use, occupational hazards (e.g., textile industry, leather manufacturing), and systemic disease (e.g., pernicious or iron deficiency anemia, HIV infection, lichen planus, previous malignancy). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
19. To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz ANS: C
Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. You are using a pneumatic attachment on the otoscope while assessing tympanic membrane
movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. change to a larger speculum. c. squeeze the bulb with more force. d. insert the speculum to a depth of 2 cm. ANS: B
To see tympanic movement when using the pneumatic attachment, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb. A soft rubber speculum is recommended to establish the seal. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorders. b. skeletal anomalies. c. renal disorders. d. heart defects. ANS: C
An auricle with a low-set or unusual angle may indicate chromosomal aberrations or renal disorders. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. When conducting an adult otoscopic examination, you should: a. position the patient’s head leaning toward you. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. ANS: C
When conducting an adult otoscopic examination, select the largest speculum that will comfortably fit in the patient’s ear. When you are conducting an adult otoscopic examination, the patient’s head should be positioned toward the opposite shoulder. Hold the handle of the otoscope between the thumb and index finger, supporting it on the middle finger. There is no reason for the patient to keep her or his eyes shut. DIF: Cognitive Level: Applying (Application) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Normal tympanic membrane color is: a. amber. b. chalky white. c. green. d. pearly gray. ANS: D
The expected normal tympanic membrane color is pearly gray. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Bulging of an amber tympanic membrane without mobility is usually associated with: a. middle ear effusion. b. healed tympanic membrane perforation. c. impacted cerumen in the canal. d. repeated and prolonged crying cycles. ANS: A
An amber color, with bulging of the tympanic membrane and without mobility or redness, usually indicates the presence of fluid in the middle ear. DIF: Cognitive Level: Applying (Application) REF: p. 241 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Severe vertigo, tinnitus, and progressive hearing loss are characteristic of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. ANS: B
The classic triad of Ménière disease is vertigo, tinnitus, and progressive hearing loss. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When hearing is evaluated, which cranial nerve is being tested? a. III b. IV c. VIII d. XII
ANS: C
Cranial nerve VIII, the vestibulocochlear nerve, is associated with hearing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Speech with a monotonous tone and erratic volume may indicate: a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. ANS: B
Speech with a monotonous tone and erratic volume may indicate hearing loss. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 241 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test
for: a. b. c. d.
air conduction of sound. bone versus air conduction. lateralization of sound. mallear auditory ability.
ANS: C
Placing the fork on the midline vertex of the patient’s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. To perform the Rinne test, place the tuning fork on the: a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. ANS: B
The fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized
to the unaffected ear; for the Rinne test, air conduction–to–bone conduction ratio is less than 2:1. You interpret these findings as suggestive of: a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen.
ANS: A
These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa and impacted cerumen are conditions of the external ear that can cause conductive hearing problems. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Nasal symptoms that imply an allergic response include: a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal membranes. d. firm consistency of turbinates. ANS: B
Nasal symptoms that imply an allergic response include bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and bone of the nose. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 243 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. You are interviewing a parent whose child has a fever, is pulling at her right ear, and is
irritable. You ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional finding is more suggestive of: a. acute otitis media. b. otitis externa. c. serous otitis media. d. middle ear effusion. ANS: A
Anorexia is an initial symptom of acute otitis media. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 256 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. A smooth red tongue with a slick appearance may indicate: a. niacin or vitamin B12 deficiency. b. oral cancer. c. recent use of antibiotics. d. fungal infection. ANS: A
A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Oral cancer involves lesions, recent use of antibiotics can turn the tongue yellow-brown to black and hairy, and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
34. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa
are: a. Fordyce spots. b. aphthous ulcers. c. Stensen ducts. d. leukoedema. ANS: B
Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa. Fordyce spots are ectopic sebaceous glands that appear on the buccal mucosa and lips as numerous small, yellow-white, raised lesions. Stensen ducts are parotid gland outlets and should appear as whitish yellow or whitish pink protrusions in approximate alignment with the second upper molar. Leukoedema appears on the buccal mucosa as a diffuse filmy grayish surface with white streaks, wrinkles, or milky alterations. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 246 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. A hairy tongue with yellowish brown to black elongated papillae on the dorsum: a. is indicative of oral cancer. b. is sometimes seen following antibiotic therapy. c. usually indicates vitamin deficiency. d. usually indicates anemia. ANS: B
Recent antibiotic use can turn the tongue yellow-brown to black and make it appear hairy. Oral cancer involves lesions. A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Pallor usually indicates anemia. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. To inspect the lateral borders of the tongue, you should: a. ask the patient to extend the tongue outward. b. insert the tongue blade obliquely against the tongue. c. lift the tongue upward with gloved fingers. d. pull the gauze-wrapped tongue to each side. ANS: D
To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. DIF: Cognitive Level: Applying (Application) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. A newborn whose serum bilirubin level is greater than 20 mg/100 mL has a risk of later: a. hearing loss. b. sinusitis. c. tooth decay. d. meningitis. ANS: A
Risk factors for hearing loss in infants include infection, irradiation, drug abuse, and syphilis in the mother, as well as birth weight less than 1500 g, excessively high bilirubin level, infections (e.g., bacterial meningitis, recurrent otitis media), cleft palate, craniofacial abnormalities, ototoxic antibiotic use, head trauma, and hypoxic episodes in infancy. DIF: Cognitive Level: Applying (Application) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Which variation may be an expected finding in the ear examination of a newborn? a. Diffuse light reflex b. Purulent material in the ear canal c. Redness and swelling of the mastoid process d. Small perforations of the tympanic membrane ANS: A
The newborn’s tympanic membrane does not become conical for several months; therefore, the light reflex appears diffuse. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. For best results, an otoscopic and oral examination in a child should be: a. conducted at the beginning of the assessment. b. done after inspection. c. performed at the end of the examination. d. performed before palpation. ANS: C
Because young children often resist an otoscopic and oral examination, it may be wise to postpone these procedures until the end, after you have gained some trust. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 251 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Which abnormality is common during pregnancy? a. Eruption of additional molars b. Hypertrophy of the gums c. Otitis externa d. Otitis media ANS: B
The gums of pregnant women may appear reddened, swollen, and spongy, with the hypertrophy resolving within 2 months of delivery. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 253 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Intense pain with movement of the pinna is most closely associated with: a. otitis media with effusion. b. otitis externa. c. purulent otitis media. d. bacterial otitis media.
ANS: B
Otitis externa (swimmer’s ear) should be suspected when pulling of the pinna reproduces ear pain. DIF: Cognitive Level: Applying (Application) REF: p. 254 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. Expected physical changes associated with older adults include: a. shiny buccal mucosa. b. shorter teeth. c. wetter nasal mucosa. d. bristly hairs in the vestibule. ANS: D
With age, the buccal mucosa becomes less shiny, teeth appear longer because of gums receding, nasal mucosa are drier, and more bristly hairs appear in the nose, especially in men. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 253 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. In adults, the length of the external auditory canal is ____ cm. ANS:
2.5 The external ear canal is approximately 2.5 cm long in adults. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When you ask the patient to identify smells, you are assessing cranial nerve __. ANS:
I The first cranial nerve, the olfactory nerve, is tested when you ask a patient to identify different smells. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 244 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the
__________ sinuses. ANS:
maxillary
The maxillary sinuses lie along the nasal cavity near the cheek, the ethmoid sinuses lie behind the frontal sinuses near the superior portion of the nasal cavity, and the paranasal sinuses are extensions of the nasal cavities within the skull. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 233 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss.
Which of the following are changes in hearing that occur in older adults? (Select all that apply.) a. Results from cranial nerve VII b. Slow progression c. Loss of high frequency d. Bone conduction heard longer than air conduction e. Sounds may be garbled, difficult to localize f. Unable to hear in a crowded room ANS: C, E, F
Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea. Sensorineural hearing loss first occurs with high-frequency sounds and then progresses to tones of lower frequency. Loss of highfrequency sounds usually interferes with the understanding of speech and localization of sound. Conductive hearing loss may result from an excess deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window, cerumen impaction, or a sclerotic tympanic membrane. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which of the following signs and symptoms occur with a sensorineural hearing loss? (Select
all that apply.) a. Air conduction shorter than bone conduction b. Lateralization to the affected ear c. Loss of high-frequency sounds d. Speaks more loudly e. Disorder of the inner ear f. Air conduction longer than bone conduction ANS: C, D, E, F
The signs and symptoms of sensorineural hearing loss include loss of high-frequency sounds, speaks more loudly, disorder of the inner ear, air conduction longer than bone conduction, and lateralization to the unaffected ear. DIF: Cognitive Level: Applying (Application) REF: p. 256 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 13: Chest and Lungs Test Bank—Nursing MULTIPLE CHOICE 1. The anteroposterior diameter of the chest is normally approximately the same as the
transverse diameter in which age group? a. Infants b. School-age children c. Adolescents d. Young adults ANS: A
The chest of infants is generally round, with equal dimensions of anteroposterior and transverse diameters. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 264 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A 44-year-old male patient who complains of a cough has presented to the emergency
department. He admits to smoking one pack per day. During your inspection of his chest, the most appropriate lighting source to highlight chest movement is: a. bright tangential lighting. b. daylight from a window. c. flashlight in a dark room. d. fluorescent ceiling lights. ANS: A
Bright tangential light is best for visualizing chest movements. DIF: Cognitive Level: Applying (Application) REF: p. 268 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. When auscultating the apex of the lung, you should listen at a point: a. even with the second rib. b. 4 cm above the first rib. c. higher on the right side. d. on the convex diaphragm surface. ANS: B
The apex of the lung is 4 cm above the first rib. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 262 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. You are documenting a rash between the eighth and ninth ribs on the lateral border. This
intercostal space will be documented in terms of the: a. rib immediately above it. b. rib immediately below it. c. number of centimeters it is positioned below the clavicle. d. number of inches it is positioned below the clavicle.
ANS: A
The number of each intercostal space corresponds to that of the rib immediately above it. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 263 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. To count the ribs and the intercostal spaces, you begin by palpating the reference point of the: a. distal point of the xiphoid. b. manubriosternal junction. c. suprasternal notch. d. acromion process. ANS: B
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second rib, the reference point for counting ribs and intercostal spaces. DIF: Cognitive Level: Applying (Application) REF: p. 263 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. When the umbilical cord is cut: a. blood flows through the infants lungs more vigorously. b. lungs fill with air. c. closure of the foramen ovale occurs d. closure of the ductus arteriosus occurs. ANS: A
The lungs fill with air at the infant’s initial first gasp. The closure of the foramen ovale occurs within minutes after birth and closure of the ductus arteriosus occurs when arterial blood flows through the lung and there is increased oxygen tension. Once the umbilical cord is cut, there is a decrease in maternal blood causing an increase in blood in the infant lungs. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 264 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Fetal gas exchange is mediated by the: a. lungs. b. heart. c. amniotic fluid. d. placenta. ANS: D
The placenta is the source of fetal gas exchange; the lungs contain no air and the alveoli are collapsed. It is not mediated by the heart. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 264 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The foramen ovale should close: a. by 24 weeks of gestation. b. within minutes of birth. c. by 4 weeks of age.
d. By 12 months of age. ANS: B
The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 264 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Increased oxygen tension in the arterial blood of a newborn infant causes: a. closure of the ductus arteriosus. b. hyperinflation of the lungs. c. passive respiratory movements. d. reopening of the foramen ovale. ANS: A
Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 264 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. To accommodate the enlarging uterus of pregnancy, chest changes result in: a. intercostal muscle atrophy. b. lowering of the resting diaphragm. c. a decrease in alveoli expansion. d. an increase in the subcostal angle. ANS: D
The subcostal angle progressively increases from approximately 68.5 to 103.5 degrees in later pregnancy. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 265 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. The characteristic barrel chest of the older adult is the result of a combination of factors,
including: a. skeletal changes of aging. b. increased muscular expansion of the chest wall. c. less fibrous alveoli. d. increased vital capacity. ANS: A
Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine, which contributes to a barrel chest. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 265 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. Nancy Walker is a 16-year-old girl who presents to the clinic with complaints of severe, acute
chest pain. Her mother reports that, apart from occasional colds, Nancy is not prone to respiratory problems. Which potential risk factor is most important to assess with regard to Nancy’s current problem? a. Anorexia symptoms b. Cocaine use c. Last menses d. Signs of rheumatic fever ANS: B
Illegal drug use of cocaine is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax. DIF: Cognitive Level: Applying (Application) REF: p. 267 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The patient tells you that she uses herbal and other alternative therapies to maintain her health.
This information is recorded in the: a. past medical history. b. chief complaint. c. social history. d. family history. ANS: C
Patient data concerning the use of herbal or other remedies and other complementary or alternative therapies are recorded in the social history component of the history and physical. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 267 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Mr. Curtis is a 44-year-old patient who has presented to the emergency department with
shortness of breath. During the history, the patient describes shortness of breath that gets worse when he sits up. To document this, you will use the term: a. platypnea. b. orthopnea. c. tachypnea. d. bradypnea. ANS: A
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens when the person lies down. Tachypnea is an increased respiratory rate. Bradypnea is a decreased respiratory rate. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 266 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Bradypnea may accompany: a. a subconscious response to observation. b. an excellent level of cardiovascular fitness. c. ascites. d. severe pain from a rib fracture.
ANS: B
Bradypnea, a respiratory rate slower than 12 breaths/min, may be seen with cardiorespiratory fitness. Tachypnea is seen with a subconscious response to observation, with ascites, and with severe pain from a rib fracture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 270 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Which chest structure contains all the thoracic viscera except the lungs? a. Manubrium b. Mediastinum c. Sternum d. Xiphoid ANS: B
The mediastinum, situated between the lungs, contains all the thoracic viscera except the lungs. The sternum is composed of the manubrium and xiphoid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 260 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies? a. Left mainstem bronchus b. Terminal bronchioles c. Right mainstem bronchus d. Respiratory bronchioles ANS: C
The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and a site for endotracheal tubes that are advanced too far. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 263 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Which finding suggests a minor structural variation? a. Barrel chest b. Clubbed fingers c. Pectus carinatum d. Chest wall retractions ANS: C
Pectus carinatum (pigeon chest) is a minor structural variation. Barrel chest, clubbing of the fingers, and chest wall retractions result from compromised respirations. DIF: Cognitive Level: Applying (Application) REF: p. 268 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Ms. Rudman, age 74 years, has no known health problems or diseases. You are doing a
preventive health care history and examination. Which symptom is associated with intrathoracic infection?
a. b. c. d.
Barrel chest Cor pulmonale Funnel chest Malodorous breath
ANS: D
Intrathoracic infections may make the breath malodorous. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 273 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. The best time to observe and count respirations is while: a. the patient is answering questions. b. weighing the patient. c. palpating the pulse. d. the patient is sleeping. ANS: C
Counting respirations while you palpate the pulse does not make the patient self-conscious because the patient expects you to be counting the pulse. Respiratory patterns change as the patient speaks. Attempting to count during weighing would make the patient self-conscious and affect the respiratory rate. Respiratory patterns change as the patient sleeps. DIF: Cognitive Level: Applying (Application) REF: p. 270 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. As you take vital signs on Mr. Barrow, age 78 years, you note that his respirations are 40
breaths/min. He has been resting, and his mucosa is pink. In regard to Mr. Barrow’s respirations, you would: a. document his rate as normal. b. do nothing because his color is pink. c. note that his rate is below normal. d. report that he has an above-average rate. ANS: D
The normal adult respiratory rate is 12 to 20 breaths/min, and the ratio of breaths to heartbeats is 1:4. A respiratory rate of 40 breaths/min is not within the normal range and should be documented as above average. DIF: Cognitive Level: Applying (Application) REF: p. 270 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. In which patient situation would you expect to assess tachypnea? a. Patient who is depressed b. Patient who abuses narcotics c. Patient with metabolic acidosis d. Patient with myasthenia gravis ANS: C
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the excess carbon dioxide. A patient who is depressed, abuses narcotics, or has myasthenia gravis would have respiratory depression.
DIF: Cognitive Level: Applying (Application) REF: p. 270 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Which term would you use to document a respiratory rate more than 20 breaths/min in an
adult? a. Dyspnea b. Orthopnea c. Platypnea d. Tachypnea ANS: D
Tachypnea is a respiratory rate greater than 20 breaths/min. Dyspnea, orthopnea, and platypnea describe respiratory effort, not rate. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 270 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Respiratory effort usually exhibited by a patient with cerebral brain damage is called: a. Cheyne-Stokes respiration. b. paroxysmal nocturnal dyspnea. c. Kussmaul breathing. d. Biot respiration. ANS: A
Cheyne-Stokes respirations occur in children and older adults during sleep, but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 271 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Which site of chest wall retractions indicates a more severe obstruction in the asthmatic
patient? a. Lower chest b. Along the anterior axillary line c. Above the clavicles d. At the nipple line ANS: C
Asthma usually causes retractions of the lower chest. The more severe the obstruction, the greater the negative pressure produced in the chest during inspiration, and retractions are manifested in the upper thorax. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 272 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. Laryngeal obstructions would elicit which breath sound? a. Fremitus b. Stridor c. Rhonchi d. Crepitus
ANS: B
Obstructions high in the respiratory tree (e.g., laryngeal obstructions) are characterized by stridor. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 272 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Mr. L has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect
that he is having cardiac or pulmonary difficulty. Which additional sign would support this impression? a. Callus formation on the heels b. Clubbing of the fingers c. Graying hair d. Swollen toes and ankles ANS: B
Clubbing of the fingers suggests pulmonary or cardiac difficulty. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 273 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of
ammonia on the breath may signify: a. uremia. b. tuberculosis. c. hepatic failure. d. diabetic ketoacidosis. ANS: A
An ammonia-like breath odor suggests uremia, a renal condition. A cinnamon-like breath odor suggests tuberculosis. A breath odor resembling musty fish or clover suggests hepatic failure. A sweet, fruity breath odor suggests diabetic ketoacidosis. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. An expected finding of chest palpation in the adult would be: a. a costal angle of 100 degrees. b. cracking over the sternal notch. c. greater right chest expansion. d. inflexibility of the xiphoid. ANS: D
The sternum and xiphoid are relatively inflexible in adults. The expected normal costal angle in the adult is 90 degrees. Cracking over the sternal notch is not an expected finding of chest palpation in the adult. Normally, the chest moves symmetrically in the adult. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 273 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. You would expect to document the presence of a pleural friction rub for a patient being treated
for:
a. b. c. d.
pneumonia. atelectasis. pleurisy. emphysema.
ANS: C
A pleural friction rub is caused by inflammation of the pleural surfaces and would be expected to be auscultated with pleurisy. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Which type of apnea requires immediate action? a. Primary apnea b. Secondary apnea c. Sleep apnea d. Periodic apnea of the newborn ANS: B
Secondary apnea is a grave condition, and unless resuscitative measures are instituted immediately, breathing will not resume spontaneously. Primary apnea is self-limiting. Sleep apnea should be evaluated but does not require immediate action. Periodic apnea of the newborn is a normal condition. DIF: Cognitive Level: Applying (Application) REF: p. 271 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. During the most effective percussion technique for the posterior lung fields, the patient
cooperates by: a. folding their arms in front. b. bending their head back. c. standing and bending forward. d. lying on the side and extending their top arm. ANS: A
Having the patient sit with their head forward and their arms folded in front moves the scapula laterally, exposing more lung to percussion. DIF: Cognitive Level: Applying (Application) REF: p. 274 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. The examiner percusses for diaphragmatic excursion along the: a. sternum. b. midvertebral line. c. midaxillary line. d. scapular line. ANS: D
The technique for diaphragmatic excursion is to percuss along the scapular line after the patient inhales deeply and then mark the site at which resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 276 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because
it: a. b. c. d.
amplifies all types of sounds. filters extraneous sounds. pinpoints focal sound areas. transmits high-pitched sounds.
ANS: D
The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung, and it has a broader area from which to listen. Unless specially modified, the stethoscope does not amplify sound, filter extraneous sounds, or pinpoint focal sound areas. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Breath sounds normally auscultated over most of the lung fields are called: a. vesicular. b. bronchovesicular. c. bronchial. d. tubular. ANS: A
The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Breath sounds normally heard over the trachea are called: a. bronchovesicular. b. amphoric. c. bronchial. d. vesicular. ANS: C
The sounds highest in intensity and pitch are the bronchial sounds, which are normally heard over the trachea. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas
healthy lung tissue produces softer sounds. This is because: a. consolidation echoes in the chest. b. consolidation is a poor conductor of sound. c. air-filled lung sounds are from smaller spaces. d. air-filled lung tissue is an insulator of sound. ANS: D
Air is a poor conductor of sound. Denser consolidation promotes louder sounds and is a better conductor of sound. Consolidation is a better conductor of sound than air. Breath sounds are easier to hear when the lungs are consolidated; the mass surrounding the tube of the respiratory tree promotes sound transmission better than air-filled alveoli. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. The middle lobe of the right lung is best auscultated in the: a. anterior chest. b. posterior chest. c. axilla. d. midclavicular line. ANS: C
The sounds of the middle lobe of the right lung are best heard in the right axilla. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia.
The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by: a. percussing all lung fields. b. auscultating the lung bases. c. determining tactile fremitus. d. estimating diaphragmatic excursion. ANS: B
Because the patient has consolidation and has been recumbent and fatigued, the most appropriate first step is to listen to the lung bases before the patient gets exhausted. The lung bases are the most likely sites of adventitious sounds. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Your trauma patient has no auscultated breath sounds in the right lung field. You can hear
adequate sounds on the left side. A likely cause of this abnormality could be that the patient: a. has a closed head injury. b. has fluid in the pleural space. c. is moaning and in severe pain. d. is receiving high-flow oxygen. ANS: B
Trauma to the chest can cause an exudative pleural effusion or pneumothorax. In the affected areas, the breath sounds are diminished to absent. DIF: Cognitive Level: Applying (Application) REF: p. 277 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. The term rales has been replaced with: a. wheezes.
b. crunches. c. rhonchi. d. crackles. ANS: D
The term rales has been replaced with the term crackles to describe the sound more precisely. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 279 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. To distinguish crackles from rhonchi, you should auscultate the lungs: a. before and after the patient coughs. b. first at the lung base and then at the apex. c. with the patient inhaling and then exhaling. d. with the patient recumbent and then sitting. ANS: A
To distinguish between crackles and rhonchi, ask the patient to cough and auscultate again over the same area. Because they reflect secretions in larger airways, rhonchi can clear with coughing. DIF: Cognitive Level: Applying (Application) REF: p. 279 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. A musical squeaking noise heard on auscultation of the lungs is called: a. a friction rub. b. rales. c. rhonchi. d. wheezing. ANS: D
Wheezing is a continuous, high-pitched musical sound that can be heard on inspiration and expiration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. To distinguish between a respiratory friction rub and cardiac friction rub, ask the patient to: a. hold the breath. b. lean forward. c. say “99” while you palpate the anterior chest. d. identify the location of the pain. ANS: A
A respiratory friction rub results when inflamed pleura rub against each other during the respiratory cycle; if the breath is held, the rub stops. DIF: Cognitive Level: Applying (Application) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. In which position can the mediastinal crunch (Hamman sign) best be heard? a. A supine position
b. Lying on the left side c. Sitting completely upright d. With the head elevated 30 degrees ANS: B
The Hamman sign occurs with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are best heard when the patient leans to the left or lies down on the left side (these maneuvers bring the heart muscle closer to the chest wall). DIF: Cognitive Level: Applying (Application) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. Changes in the clarity and volume of spoken sounds during auscultation of the lungs can help
you distinguish: a. consolidation from airway constriction. b. a foreign body from a purulent exudate. c. pulmonary edema from pleurisy. d. right from left tracheal deviation. ANS: A
When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish adventitious breath sounds caused by consolidation from those caused by narrowing of a patent lumen. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. During a chest assessment, you note the patient’s voice quality while auscultating the lung
fields. The voice sound is intensified, the voice has a nasal quality, and the e’s sound like a’s. This is indicative of: a. lung consolidation. b. emphysema. c. bronchial obstruction. d. asthma. ANS: A
Vocal resonance, as described, indicates lung consolidation. Sounds are transmitted more clearly through consolidation rather than air. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. While auscultating the lung fields, you note that the patient’s voice sound is intensified, the
voice has a nasal quality, and e’s sound like a’s. This describes: a. resonance. b. bronchophony. c. pectoriloquy. d. egophony. ANS: D
Egophony is marked by increased intensity of the spoken voice, a nasal quality to the voice, and e’s that become stuffy, broad a’s.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 280 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. Tactile fremitus is best felt: a. along the costal margin and xiphoid process. b. in the suprasternal notch along the clavicle. c. parasternally at the second intercostal space. d. posterolaterally beneath the scapula. ANS: C
Fremitus is best palpated at the second intercostal space, which also corresponds to the bifurcation of the bronchi. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 273 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. How is the sputum of a viral infection different from the sputum of a bacterial infection? a. Sputum production is greater with viral conditions than with bacterial infections. b. The sputum is odorous in viral conditions and nonodorous in bacterial infections. c. The sputum is yellow, green, or rust-colored in bacterial infections and mucoid in
viral infections. d. The sputum is much thinner in bacterial infections than in viral infections. ANS: C
The characteristic most likely to differentiate viral sputum from bacterial sputum is the sputum’s color. Viral infections typically produce mucoid sputum, whereas bacterial infections produce yellow, green, or rust-colored sputum. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 266 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 51. A cause for alarm during chest assessment of a newborn is: a. crackles. b. rhonchi. c. gurgles from the gastrointestinal tract. d. stridor. ANS: D
Stridor is alarming at any age. Crackles and rhonchi at birth are caused by the presence of remaining fetal fluid and are not a cause for alarm. Intermittent gurgles are bowel sounds transmitted through the thin-walled chest and are not a cause for alarm. DIF: Cognitive Level: Applying (Application) REF: p. 282 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 52. Which of the following is an expected finding in newborns ? a. Mottling of the thorax b. Sternal retractions c. Cough d. Sneezing
ANS: D
Sneezing is common in infants; it is frequent and expected and clears the nose. Other findings that would be a concern in adults but not in infants are respiratory grunting and periodic breathing. Mottling of the thorax and sternal retractions are signs of distress in all ages. Cough is rare in the newborn and would be considered a problem. DIF: Cognitive Level: Applying (Application) REF: p. 281 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 53. Loud, harsh bronchovesicular breath sounds in young children are an indication of: a. the accumulation of fluid. b. malignant tumors or solid masses. c. normal, thin chest wall structures. d. pus-filled abscesses and tumors. ANS: C
The chest wall of a young child is usually thin and therefore normally able to transmit loud, harsh, and more bronchial breath sounds than are heard in adults. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 282 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 54. A pregnant woman is expected to develop: a. tachypnea and decreased tidal volume. b. deep breathing but not more frequent breathing. c. dyspnea and increased functional residual capacity. d. bradypnea and increased tidal volume. ANS: B
In a pregnant woman, the tidal volume and vital capacity increase, the functional residual capacity decreases, and the woman breathes more deeply but not more frequently. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 282 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 55. Expected respiratory changes of normal aging include: a. increased chest expansion. b. more frequent use of respiratory muscles. c. accentuated lumbar curve. d. more prominent bony structures. ANS: D
Marked bony prominences are seen in older adults because of the loss of subcutaneous tissue. Chest expansion is decreased in older adults. Older adults show less use of their respiratory muscles because of muscle weakness. The lumbar curve is flattened in older adults. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 282 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 56. Which symptom is the most significant indicator of asthma and should be identified in the
health history? a. Wheezing
b. Paroxysmal dyspnea c. Coexistent skin conditions d. Chest pain ANS: B
All the symptoms listed are associated with asthma; however, a paroxysmal dyspnea is a hallmark subjective component. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 284 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 57. Dullness to percussion in intercostal spaces suggests the presence of: a. cor pulmonale. b. empyema. c. pneumonia. d. sickle cell disease. ANS: C
Resonance is the expected percussion tone over normal lung tissue, which is accessible in the intercostal spaces. Dullness indicates an area of consolidation, as seen with pneumonia. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 288 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 58. Which condition requires immediate emergency intervention? a. Patient with pleuritic pain without dyspnea b. Patient with fever and a productive cough c. Patient with tachypnea but no chest retractions d. Patient with absent breath sounds and dull percussion tones ANS: D
Absent breath sounds can indicate that the client is moving no, air such as in a severe asthma attack, and would require immediate intervention. Impending respiratory arrest is indicated by absence of breath sounds and often respiratory arrest is exacerbated by the presence of infectious processes that would cause dull percussion tones. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 286 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 59. A 29-year-old patient presents with a new complaint of productive cough, with purulent
sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in which lobe? a. Right lower b. Right upper c. Left upper d. Left lower ANS: A
Right lower lobe pneumonia can stimulate the tenth thoracic nerve, causing right lower quadrant pain and simulating an abdominal process. DIF: Cognitive Level: Applying (Application)
REF: p. 288
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
60. Which of the following are signs and symptoms of atelectasis? a. Diminished chest wall movement b. Tachypnea c. Bradypnea d. Trachea deviated ipsilaterally e. Wheezes, rhonchi, and crackles f. Resonance over affected lung ANS: B
Signs and symptoms of atelectasis tachypnea, shortness of breath, tachycardia, cough, chest pain, low-grade fever (if associated with surgery),and cyanosis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 285 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Both pleural effusion and lobar pneumonia are characterized by ______________ percussion. ANS:
dullness heard on Pleural effusion and lobar pneumonia are denser than air, with an expected finding of dullness on percussion. Tympany is expected over hollow organs, such as the stomach; resonance and hyperresonance are heard over air-filled areas. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 288 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The respiratory rate of a sleeping newborn is expected to be _____ breaths/min. ANS:
40 to 60 The expected respiratory rate for infants is 40 to 60 breaths/min. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 282 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. In barrel chest, the ratio of the anteroposterior diameter to the transverse (lateral) diameter is
_____. ANS:
1.0 In a barrel chest, an increase in the chest anteroposterior diameter leads to an increase in the thoracic ratio (anteroposterior-to-transverse diameter ration) of 1.0, wherein the chest is as wide as it is thick.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 268 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 14: Heart Test Bank—Nursing MULTIPLE CHOICE 1. Which two heart chambers are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle ANS: C
The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 295 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The condition in which a patient’s heart is rotated or displaced to the right or is situated as a
mirror image of the expected position is called: a. amyloidosis. b. coarctation. c. dextrocardia. d. situs inversus. ANS: C
Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Coarctation is the compression of the walls of a vessel, such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 294 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Heart position can vary depending on body habitus. In a short stocky individual, you would
expect the heart to be located: a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. ANS: B
The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall slender person’s heart tends to hang vertically and is positioned centrally. A stocky short person’s heart tends to lie more to the left and more horizontally. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 294 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. Which cardiac structure is responsible for the heart’s pumping action? a. Pericardium b. Epicardium c. Myocardium d. Endocardium ANS: C
The myocardium is the thick muscular middle layer responsible for the pumping action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects the heart. The epicardium is the thin outermost muscle layer that covers the heart and extends onto the great vessels. The endocardium is the innermost layer that lines the chambers of the heart and covers heart valves. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 295 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Contraction of the ventricles causes: a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the auricular septa. d. opening of the mitral and tricuspid valves. ANS: A
When the ventricles contract the semilunar valves, the pulmonic and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 297 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Which two structures together form the primary muscle mass of the heart? a. Right and left ventricles b. Left ventricle and the aorta c. Right and left atria d. Left atrium and the pulmonary vein ANS: A
The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atria pump blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 295 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The major heart sounds are normally created by: a. valves opening. b. valves closing.
c. the rapid movement of blood. d. rubbing together of the cardiac walls. ANS: B
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1, “lub.” When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2, “dub.” Valve opening is usually a silent event. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 297 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Ms. Sharpe is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On
auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect: a. angina. b. acute rheumatic fever. c. cardiac amyloidosis. d. aortic sclerosis. ANS: B
Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often, the valve becomes stenotic and regurgitant. Prevention is adequate treatment of the streptococcal pharyngitis or skin infection. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 331 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. A grade IV mitral regurgitation murmur would: a. be described as a diastolic murmur. b. not be expected to have a thrill. c. radiate to the axilla. d. be heard best at the base. ANS: C
A grade IV murmur would have a thrill; a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla. DIF: Cognitive Level: Applying (Application) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of
the stimulus through the atria is the: a. P wave. b. PR interval. c. QRS complex. d. ST segment. ANS: A
The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 299 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. The pacing structure of the heart’s electrical activity is the: a. AV node. b. bundle of His. c. Purkinje fibers. d. sinoatrial (SA) node. ANS: D
An electrical impulse stimulates each myocardial contraction; this impulse originates in and is paced by the SA node. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 299 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Purkinje fibers are located in the: a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch. ANS: C
The Purkinje fibers are located in the ventricular myocardium. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 299 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the
ECG as the: a. P wave. b. QRS complex. c. PR interval. d. T wave. ANS: B
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of stimulated ventricular muscle to a resting state. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 299 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. In the fetus, the right ventricle pumps blood through the: a. left atrium.
b. ductus arteriosus. c. lungs. d. foramen ovale. ANS: B
The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs, not through the left atrium, lungs, or foramen ovale. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. In what age group are the right and left ventricles equal in weight and muscle mass? a. Newborns b. School-age children c. Adolescents d. Older adults ANS: A
At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and interatrial foramen ovale causes pressure in the left atrium to increase. At this time, the right ventricles demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older adults, the left ventricle wall thickens and the valves become fibrotic and calcified. The right and left ventricles are not equal in weight and muscle mass in school-age children, adolescents, or older adults. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Closure of the ductus arteriosus usually occurs: a. 24 to 48 hours after birth. b. after 7 days of life. c. between the second and third month. d. during the toddler period. ANS: A
Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. The apex of a 2-month-old baby’s heart typically lies closest to the: a. fourth left intercostal space. b. midsternal area. c. midthoracic spinal area. d. sixth left intercostal space. ANS: A
In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Normal cardiac changes that occur during pregnancy include: a. decreased cardiac output. b. increased thickness and mass of the left ventricle. c. decreased heart rate. d. dilation of the ventricles. ANS: B
The maternal blood volume increases by 40% to 50% because of an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), thereby resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally and there is a slight axis rotation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation ANS: D
Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 300 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Mr. O, age 50 years, comes for his annual health assessment, which is provided by his
employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should: a. ask if he makes his own bed daily. b. have the patient describe his exercise. c. make a note that he walks each day. d. record “light exercise” in the history. ANS: B
When Mr. O says that he engages in light exercise, have him describe his exercise. To qualify his use of the term light, ask him the type, length of time, frequency, and intensity of his activities. DIF: Cognitive Level: Applying (Application) REF: p. 304 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Pleural pain differs from chest discomfort caused by other conditions in that it is: a. precipitated by coughing.
b. eased with deep breathing. c. usually described as dull in nature. d. related to time of day. ANS: A
Pleural pain is precipitated by breathing and coughing and is usually described as a sharp pain that is present during respirations and absent during breath-holding. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 302 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which of the following information belongs in the past medical history section related to heart
and blood vessel assessment? a. Adolescent inguinal hernia b. Childhood mumps c. History of bee stings d. Previous unexplained fever ANS: D
Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 301-302 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. A patient you are seeing in the emergency department for chest pain is believed to be having a
myocardial infarction. During the health history interview of his family history, he relates that his father had died of “heart trouble.” The most important follow-up question you should pose is which of the following? a. “Did your father have coronary bypass surgery?” b. “Did your father’s father have heart trouble also?” c. “What were your father’s usual dietary habits?” d. “What age was your father at the time of his death?” ANS: D
A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one’s chance of a similar occurrence. DIF: Cognitive Level: Applying (Application) REF: p. 303 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Which one of the following is a common symptom of cardiovascular disorders in the older
adult? a. Fatigue b. Joint pain c. Poor night vision d. Weight gain ANS: A
Common symptoms of cardiovascular disorders in older adults include confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or tightness, impotence, fatigue, and leg edema. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 304 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. In the adult, the apical impulse should be most visible when the patient is in what position? a. Supine b. Upright c. Lithotomy d. Right lateral recumbent ANS: B
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. In most adults, the apical impulse will not be visible in the upright, lithotomy, or right lateral recumbent positions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 305 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. If the apical impulse is more vigorous than expected, it is called a: a. lift. b. thrill. c. bruit. d. murmur. ANS: A
If the apical impulse is more vigorous than expected, it is referred to as a lift or heave. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound caused by turbulent blood flow into, through, or out of the heart. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. A palpable rushing vibration over the base of the heart at the second intercostal space is called
a: a. b. c. d.
heave. lift. thrill. thrust.
ANS: C
A thrill is a fine, palpable, rushing vibration—a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A lift is another term for a heave, which is a more vigorous apical impulse. A thrust is sudden, forcible forward movement.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. An apical PMI palpated beyond the fifth intercostal space may indicate: a. decreased cardiac output. b. obesity. c. left ventricular hypertrophy. d. hyperventilation. ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. A lift along the left sternal border is most likely the result of: a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy. ANS: D
A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect. DIF: Cognitive Level: Applying (Application) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. To estimate heart size by percussion, you should begin tapping at the: a. anterior axillary line. b. left sternal border. c. midclavicular line. d. midsternal line. ANS: A
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border. DIF: Cognitive Level: Applying (Application) REF: pp. 306-307 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Normal heart sounds are best heard: a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum.
ANS: B
Normal heart sounds are best heard in areas where the blood flows after it passes through a valve in the direction of blood flow. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 308 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. To hear diastolic heart sounds, you should ask patients to: a. lie on their back. b. lie on their left side. c. lie on their right side. d. sit up and lean forward. ANS: B
Left lateral recumbent is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position in which to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating the right rotated heart of dextrocardia. DIF: Cognitive Level: Applying (Application) REF: p. 305 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. A third heart sound is created by: a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles. ANS: C
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria; the filling sometimes produces a third heart sound, S3. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 310 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound
becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely: a. S1. b. S2. c. S3. d. S4. ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole; it is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration. DIF: Cognitive Level: Applying (Application) REF: p. 310 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
35. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing: a. a pericardial friction rub. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. ANS: A
Using the bell of the stethoscope at the apex is more useful for hearing low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position. DIF: Cognitive Level: Applying (Application) REF: p. 311 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. You are conducting an examination of Mr. Curtis’s heart and blood vessels and auscultate a
grade III murmur. The intensity of this murmur is: a. barely discernible. b. moderately loud. c. loud with palpable thrill. d. very loud without a stethoscope. ANS: B
The intensity of a grade III murmur is described as moderately loud. Barely discernible is a grade I murmur. Loud with a palpable thrill is a grade IV murmur. Very loud without a stethoscope is a grade VI murmur. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 313 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. A grade I or II murmur, without radiation and of medium pitch, is a common variation found
in: a. b. c. d.
school-age children. older women. middle-age men. older adults.
ANS: A
Many murmurs, particularly in children and adolescents, and especially in young athletes, have no apparent cause. These are usually grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by a splitting of S2. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 317 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. An example of a functional heart murmur is one that is caused by: a. anemia. b. a ventricular septal defect. c. an atrial septal defect. d. mitral valve prolapse. ANS: A
A functional heart murmur is a harmless heart murmur made by a healthy heart beating strongly. High-output demands that increase the speed of blood flow can cause murmurs. Anemia, pregnancy, and thyrotoxicosis can cause these functional heart murmurs. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 314 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. Mr. Jones and his wife have brought in their infant daughter for a routine visit. A holosystolic
murmur in an infant that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck is indicative of: a. a ventricular septal defect. b. patent ductus arteriosus. c. pulmonary stenosis. d. dextrocardia. ANS: A
Regurgitation through the ventricular septal defect results in a holosystolic murmur that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 328 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. A split second heart sound is: a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration. ANS: B
Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 308 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. The earliest sign of heart failure in an infant is frequently: a. liver enlargement. b. fluid in the lungs. c. enlarged thyroid. d. clubbing of the fingers. ANS: A
If heart failure is suspected, note that the infant’s liver may enlarge before there is any suggestion of fluid in the lungs and the left lobe of the liver may be more distinctly enlarged than the right. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 319 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
42. Chest pain with an organic cause in a child is most likely the result of: a. cardiac disease. b. asthma. c. esophageal reflux. d. arthritis. ANS: B
Unlike chest pain in adults, chest pain in children and adolescents is seldom caused by a cardiac problem. More likely, the case is related to trauma, exercise-induced asthma, or cocaine use. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 302 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus arrhythmia ANS: D
Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 319 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an
expected finding in: a. adults under stress. b. 4-year-old children. c. pregnant women. d. premature infants. ANS: B
Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child (4 years old) varies in a cyclic pattern, usually faster on inspiration and slower on expiration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 319 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. A condition that is likely to present with dizziness and syncope is: a. bacterial endocarditis. b. hypertension. c. sick sinus syndrome. d. pericarditis. ANS: C
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent syncope, transient dizzy spells, light-headedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunction, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis, along with a triphasic friction rub. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 324 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to
suspect: a. congestive heart failure. b. pericarditis. c. endocarditis. d. cardiac tamponade. ANS: B
Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy. The auscultation of a triphasic friction rub in a patient with acute chest pain should not lead you to suspect congestive heart failure, endocarditis, or cardiac tamponade. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 322 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms
of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of: a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis. ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and sudden onset of congestive heart symptoms. The lesions described are Janeway lesions. DIF: Cognitive Level: Applying (Application) REF: pp. 320-321 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. The thin-walled reservoirs of the heart are the: a. atria. b. pericardium. c. sinuses. d. ventricles. ANS: A
The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the venous system. The pericardium is a double-walled, , fibroserous sac enclosing the heart and the bases of the great vessels. A sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The ventricles are the primary muscle mass of the heart. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 295 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. Fat deposits in the circulatory system of an older adult can lead to: a. diffuse conduction disturbances. b. exaggerated contractility. c. heart failure. d. thinning of the ventricles. ANS: C
Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 330 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. The most helpful finding in determining left-sided heart failure is: a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S3 heart sound. ANS: C
Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 321 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. During the auscultation of heart tones, you are uncertain whether the sound you hear is an S2
split. You should ask the patient to inhale deeply while listening at the ______ area. ANS:
pulmonic Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site. DIF: Cognitive Level: Applying (Application) REF: p. 310 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The heart sound that coincides with the carotid pulse is ________. ANS:
S1 S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 306 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Your patient has been diagnosed with pericarditis. Which of the following are signs and
symptoms, or a precipitating factor? (Select all that apply.) a. Sharp pain b. Pain relieved by sitting up c. Pain relieved by resting d. Friction rub heard to right of sternum e. History of kidney failure f. Result of viral infection g. Result of medications such as procainamide ANS: A, B, E, F, G
Pericarditis maybe seen with a viral infection, kidney failure, or medications such as procainamide. Symptoms include pain relieved by sitting up or leaning forward. A friction rub is heard at the left of the sternum, at the third or fourth intercostal space. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 322 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 15: Blood Vessels Test Bank—Nursing MULTIPLE CHOICE 1. The structure that carries oxygenated blood to the body from the left ventricle is the: a. aorta. b. pulmonary artery. c. pulmonary vein. d. superior vena cava. ANS: A
The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior vena cava carries blood from the upper body to the right atrium. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 332 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Induration, edema and hyperpigmentation are common associated findings with which of the
following? a. Peripheral arterial disease b. Venous ulcer c. Arterial embolic disease d. Venous thrombus ANS: B
A venous ulcer also results from chronic venous insufficiency and demonstrates induration edema and hyperpigmentation. Peripheral arterial edema results in ischemia, in which the foot or leg is painful and cold; nonulceration is common as the muscles atrophy. Arterial embolic disease includes occlusion of the small arteries, resulting in blue toe syndrome and splinter hemorrhages in the nail bed. A venous thrombus presents with minimal ankle edema, lowgrade fever, tachycardia, and possibly a positive Homan sign. DIF: Cognitive Level: Applying (Application) REF: p. 349 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential 3. In which location would carotid bruits be heard best? a. Posterior cervical triangle b. Anterior margin of the sternocleidomastoid muscle c. Over the aortic valve d. At the angle of the mandible ANS: B
Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 342 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 4. The characteristics of arterial pulses are directly affected by all the following except:
a. b. c. d.
the volume of blood ejected. peripheral arterial resistance. venous valvular competence. blood viscosity.
ANS: C
Arterial pulses are not affected by venous valvular competence. Venous valvular competence contributes to the venous blood flow back to the heart. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 5. The most prominent component of the jugular venous pulse is the: a. a wave. b. c wave. c. v wave. d. x slope. ANS: A
The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 6. In newborn infants, closure of the ductus arteriosus usually occurs: a. 12 to 14 hours after birth. b. after 7 days of life. c. between the second and third months. d. during the toddler period. ANS: A
The ductus arteriosus usually closes within the first 12 to 14 hours of life. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 337 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. Mrs. Carrol is a 33-year-old patient who is pregnant and presents for a routine checkup. On
examination, you note that her blood pressure has decreased. Blood pressure normally decreases during which period? a. First trimester of pregnancy b. Second trimester of pregnancy c. Third trimester of pregnancy d. Labor and delivery ANS: B
Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension usually occurs when the patient is lying in the supine position. DIF: Cognitive Level: Applying (Application) REF: p. 337 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
8. During a routine prenatal visit, Ms. T was noted as having dependent edema, varicosities of
the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings: a. are usual conditions during pregnancy. b. indicate a need for hospitalization. c. indicate the need for amniocentesis. d. suggest that she is having twins. ANS: A
Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. This occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. DIF: Cognitive Level: Applying (Application) REF: p. 337 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 9. Vascular changes expected in the older adult include: a. loss of vessel elasticity. b. decreased peripheral resistance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. ANS: A
With age, the walls of the arteries become calcified and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 337 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 10. Persons of Irish or German descent and genetically predisposed women who take birth control
pills are at risk for developing: a. kidney dysfunction. b. liver disease. c. renal calculi. d. varicose veins. ANS: D
Genetically predisposed women who take birth control pills are at risk for developing varicose veins. Other risk factors include female gender, being a daughter of a woman with varicosities, leading a sedentary lifestyle, old age, and being white. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 338 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. The amplitude of pulses is recorded on a(n): a. Likert scale of absent to bounding. b. numeric scale of 0 to 4. c. alphabetic scale of A to E. d. descriptive scale of mild, moderate, and severe.
ANS: B
The amplitude of pulses is recorded on a numeric scale of 0 to 4—0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 12. Which of the following statements is true regarding the examination of peripheral arteries? a. The thumb should not be used to assess pulses. b. Palpate at least one pulse in each extremity, usually the most proximal one. c. The pulses are most readily felt over bony prominences. d. Extremity pulses do not normally generate waveforms. ANS: C
A pulse is most readily felt over a bony prominence. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. The most distal pulse, not the most proximal one, in each extremity is palpated to determine the sufficiency of the arterial circulation. Extremity pulses generate waveforms. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 13. Which arterial pulse is most useful for evaluating heart activity? a. Femoral b. Radial c. Temporal d. Carotid ANS: D
Carotid arteries are the most easily accessible arterial pulse and closest to the heart; therefore, the carotid pulse is the most useful for evaluating heart activity. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 338-339 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 14. A pulsation that is diminished to the point of being barely palpable would be graded as: a. 0. b. 1. c. 2. d. 3. ANS: B
A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 15. The term claudication refers to: a. pain from muscle ischemia. b. lack of palpable pulsations.
c. visible extremity changes of arterial occlusion. d. numbness and tingling in toes and fingers. ANS: A
Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease (PAD) experience claudication because of the decrease in the amount of blood passing through the artery as a result of atherosclerosis, which causes arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 16. Conduction system impairment should be suspected if an irregular heartbeat is: a. galloping. b. paradoxical. c. loud. d. weak. ANS: B
A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration. Conduction system impairment would not be suspected if an irregular heartbeat is loud or weak. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 341 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 17. An idiopathic spasm of arterioles in the digits is termed: a. arteriosclerosis obliterans. b. giant cell arteritis. c. Raynaud disease. d. a peripheral arterial aneurysm. ANS: C
Raynaud disease is idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects the carotid, temporal, and occipital arteries. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. Aneurysms occur in the aorta, renal, femoral, and popliteal arteries. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 18. A major risk factor for arterial embolic disease is: a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy.
ANS: B
Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 19. You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of
the following physical findings is consistent with the diagnosis of peripheral arterial disease? a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of extremity in contrast to other body parts d. Loss of hair over the extremities ANS: D
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area, and loss of hair over the extremities. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 20. You are performing a physical examination on a 46-year-old male patient. His examination
findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is: a. an aortic aneurysm. b. an arteriovenous fistula. c. tricuspid stenosis. d. tricuspid regurgitation. ANS: D
An aneurysm is a localized isolation that results in a pulsatile swelling and a thrill or bruit. An arteriovenous fistula is a pathologic communication between an artery and vein resulting in a thrill or bruit and edema or ischemia in the involved extremity. Tricuspid regurgitation results in a holosystolic murmur in the tricuspid region, a pulsatile liver, and peripheral edema. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 348 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential 21. A sound similar to a murmur that is heard over arteries is a: a. thrill. b. heave. c. friction rub. d. bruit. ANS: D
A bruit is the sound of turbulent blood flow that is auscultated over the arteries and heard best with the bell of the stethoscope. Thrills, as well as heaves, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together, as occurs with pericardial or pleural inflammation.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 22. A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud
phenomenon includes which of the following? a. Vasospasm. b. Digital ischemia with pain. c. Triphasic demarcated skin. d. Cold and achy improving with warming. ANS: B
In primary Raynaud phenomenon, there is triphasic demarcation of the skin—white, cyanotic, and reperfused— and vasospasm that lasts a minutes to less than an hour, areas of cold, and an achy feeling that improves with rewarming. In secondary Raynaud phenomenon, there is intense pain from digital ischemia. DIF: Cognitive Level: Applying (Application) REF: p. 347 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 23. In children, coarctation of the aorta should be suspected if you detect: a. a delay between the radial and femoral pulses. b. a simultaneous radial and femoral pulse. c. an absent femoral pulse on the left. d. bilateral absence of femoral pulses. ANS: A
Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch, near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay and/or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. Coarctation of the aorta should not be suspected if the radial and femoral pulses are palpated simultaneously, if the femoral pulse on the left is absent, or if there is bilateral absence of femoral pulses. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 348 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 24. Kawasaki disease is suspected when assessment of a child reveals: a. conjunctival injection, strawberry tongue, and edema of the hands and feet. b. conjunctival infection, lymphadenopathy, and a vesicular rash. c. low-grade fever, strawberry tongue, and edema of the hands and feet. d. dermatomal bullae rash, high fever, and cyanotic hands and feet. ANS: A
Kawasaki disease is an acute illness whose cause is uncertain. It usually affects children younger than 4 years, males more often than females. Clinical manifestations are fever lasting a few days to 3 weeks, a systemic vasculitis with conjunctival infection, strawberry tongue, edema of the hands and feet, some lymphadenopathy, and polymorphous nonvesicular rashes. DIF: Cognitive Level: Analyzing (Analysis)
REF: p. 349
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Reduction of Risk Potential
25. Which of the following statements is true regarding the development of venous ulcers in older
adults? a. The major symptom is severe leg pain, especially when walking. b. The affected leg is commonly pale and hairless, and pulses are difficult to palpate. c. Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors. d. The ulcers are generally located on the tips of toes. ANS: C
Venous ulcers are generally found on the medial or lateral aspects of the lower limbs, most often in older adults. Induration, edema, and hyperpigmentation are common. Heart failure, hypoalbuminemia, peripheral neuropathy, diabetes mellitus, nutritional deficiencies, and arterial disease cause the venous ulcers to develop. The major symptom of venous ulcers is not severe leg pain. In patients with venous ulcers, the affected leg is not commonly pale and hairless, and pulses are not difficult to palpate. Venous ulcers are not generally located on the tips of toes. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 349 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 26. When examining arterial pulses the thumb may be used: a. especially if vessels have a tendency to move. b. never for palpating pulses. c. checking the jugular venous pressure. d. during the Allen test. ANS: A
The thumb may be used, especially if the vessels have a tendency to move when probed by the fingers. The thumb is particularly useful in fixing the brachial and even the femoral pulses. You cannot palpate for jugular venous pressure waves. The Allen test is used to ensure ulnar patency prior to radial artery puncture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 27. In differentiating between an occluded artery and occluded vein, a distinguishing sign (present
in venous but not arterial occlusion) is: a. color change. b. edema. c. pain with walking. d. pain with palpation. ANS: B
Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 344 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 28. To assess a patient’s jugular veins, the patient should first be placed in which position?
a. b. c. d.
Supine Semi-Fowler Upright Left lateral recumbent
ANS: A
To assess jugular veins, place the patient in the supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the pulsations of the jugular vein become visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 342 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 29. Observation of hand veins can facilitate assessment of: a. mitral valve competency. b. a heart murmur. c. right heart pressure. d. left heart pressure. ANS: C
Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and use a ruler to measure the vertical distance between the midaxillary line (level of the heart) and the level of the collapsed hand veins. DIF: Cognitive Level: Applying (Application) REF: p. 343 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 30. You are assessing Mr. Z’s fluid volume status as a result of heart failure. If your finger
depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as: a. 1+. b. 2+. c. 3+. d. 4+. ANS: C
Pitting edema to 6 mm represents a 3+ rating. This edema is noticeably deep and may last more longer a minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1+) through worse (4+). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 31. If pitting edema is unilateral, you would suspect occlusion of a: a. lymphatic duct. b. major vein. c. surface capillary. d. superficial artery. ANS: B
If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 344 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 32. Thrombosis of a leg vein should be suspected if the patient feels calf pain: a. after running a marathon. b. on dorsiflexion of the foot. c. on extending a flexed thigh. d. while wearing high-heeled shoes. ANS: B
Deep vein thrombosis should be suspected if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 33. Which of the following statements is most accurate in describing hepatojugular reflux? a. It is an accurate indicator of heart failure. b. It is exaggerated in patients with right heart failure. c. It is normal when patients are sitting up straight. d. It should be absent in older patients with heart failure. ANS: B
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. Use your hand and apply firm pressure to the abdomen in the midepigastric region while the patient breathes regularly. Observe the neck for increased jugular venous pressure (JVP) followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and release of the abdominal hand pressure. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 34. You are performing jugular venous pressure measurement for your patient in heart failure. You
see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to: a. record this measurement as less than 9 cm H2O pressure. b. record this measurement as more than 9 cm H2O pressure. c. confirm that the pulsations decrease with inspirations. d. confirm that the pulsations increase with inspirations. ANS: C
Confirmation that you are assessing venous pressure, rather than a carotid wave pulse, is necessary. The jugular venous pulse will decrease on inspiration and increase on expiration, whereas the carotid pulse will not be affected. DIF: Cognitive Level: Applying (Application) REF: p. 342 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
35. A bounding pulse in an infant may be associated with: a. patent ductus arteriosus. b. coarctation of the aorta. c. decreased cardiac output. d. peripheral vaso-occlusion. ANS: A
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between the upper extremities or between the femoral and radial pulses, and absence of the femoral pulse, suggest a coarctation of the aorta. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 341 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 36. In infants or small children, a capillary refill time of 4 seconds: a. is normal. b. indicates hypervolemia. c. indicates dehydration or hypovolemic shock. d. indicates renal artery stenosis. ANS: C
Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill time will be longer than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 345 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 37. A venous hum heard over the internal jugular vein of a child: a. usually signifies untreatable illness. b. usually has no pathologic significance. c. usually requires surgical intervention. d. must be monitored until the child is grown. ANS: B
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. It is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 345 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 38. In pregnancy, blood pressure is at its lowest at: a. conception. b. 4 to 12 weeks. c. 16 to 20 weeks.
d. time of delivery. ANS: C
In pregnancy, the lowest level of blood pressure occurs in the second trimester (16 to 20 weeks). DIF: Cognitive Level: Applying (Application) REF: p. 337 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 39. You are palpating bilateral pedal pulses and cannot feel one of the pulses. The feet are equally
warm. You find that both great toes are pink, with a capillary refill within 2 seconds. Which of the following statements is correct? a. Immediate emergency surgery is indicated. b. Pedal pulses are not always palpable. c. Unilateral pulses are never normal. d. Venogram studies will be needed. ANS: B
Dorsalis pedis and posterior tibia pulses may be difficult to palpate or may not be palpable in some well persons. The feet are warm and capillary refill is less than 2 seconds; there is adequate circulation to the feet. Immediate emergency surgery is not indicated. Unilateral pulses may be normal. Venogram studies will not be needed. DIF: Cognitive Level: Applying (Application) REF: p. 340 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential COMPLETION 1. The arterial pulse is produced by ____________________. ANS:
ventricular systole Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is a function of peripheral vascular resistance. DIF: Cognitive Level: Applying (Application) REF: p. 336 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. The level at which the jugular venous pulse is visible gives an indication of
_________________________. ANS:
right atrial pressure The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 336 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. When palpating the carotid artery, which of the following is most important? (Select all that
apply.) a. Rotate the patient’s head to the side being examined to relax the sternocleidomastoid. b. Excessive carotid sinus massage can compromise blood flow to the brain. c. Excessive carotid sinus massage can cause slowing of the pulse. d. Palpate both sides simultaneously. ANS: A, B, C
When palpating the carotid arteries, never palpate both sides simultaneously. Excessive carotid sinus massage can cause slowing of the pulse and a drop in blood pressure and can compromise blood flow to the brain, leading to syncope. If you have difficulty feeling the pulse, rotate the patient’s head to the side being examined to relax the sternocleidomastoid muscle. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 339 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Which of the following are risk factors for varicose veins? (Select all that apply.) a. Gender b. Alcohol use c. Lower extremity trauma d. Increased body mass e. Hypertension f. Diabetes ANS: A, C, D
Gender (women are four times more likely than men to have varicose veins— geneticpredisposition), tobacco use, increased body mass, age, and history of lower extremitytrauma are all risk factors for varicose veins. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 338 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
Chapter 16: Breasts and Axillae Test Bank—Nursing MULTIPLE CHOICE 1. Which of the following arteries provides blood supply to the breast? a. Retromammary and external mammary b. Lateral thoracic and internal mammary c. Medial thoracic and internal mammary d. Lateral thoracic and external mammary ANS: B
The lateral thoracic and internal mammary arteries provide most of the blood supply to the breast and nipple tissues. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Which breast structure drains milk from each lobe onto the surface of the nipple? a. Axillary drain b. Lactiferous duct c. Latissimus dorsi d. Tail of Spence ANS: B
The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The largest amount of glandular breast tissue lies in the: a. area next to the ribs. b. lower half of chest. c. tail of Spence. d. upper outer quadrant. ANS: D
The greatest amount of glandular tissue in the breast lies in the upper outer quadrant. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 4. For purposes of examination and communication of physical findings, the breast is divided
into: a. halves (upper and lower). b. thirds (left, middle, and right). c. four quadrants plus a tail. d. circles (six consecutive rings, each 1 inch farther away from nipple). ANS: C
The breast is referenced according to five segments: four quadrants and a tail. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 5. Contraction of breast smooth muscle results in: a. benign breast lumps. b. the emptying of milk ducts. c. nipple inversion. d. nipple tenderness. ANS: B
Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the milk ducts to empty. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 6. Montgomery tubercles are most prominent in the breasts of: a. adult males. b. patients with lung disease. c. pregnant women. d. pubertal females. ANS: C
Montgomery tubercles undergo hypertrophy and become more prominent in the breasts of pregnant and lactating women. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 353 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. Mrs. Simmler brings in her adolescent daughter for a routine physical examination. As you are
explaining the health promotion activities, you remind the patient that approximately 75% of females are menstruating by which Tanner stage of breast development? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 ANS: D
Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. About 25% of females begin menstruation at stage 3. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 352 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 8. During pregnancy, which of the following changes normally occurs in the breasts because of
the effects of luteal and placental hormones? a. The amount of connective tissue increases. b. The epithelial secretory activity decreases. c. The alveoli increase in size and number. d. Vascularization decreases.
ANS: C
Breast changes during pregnancy include lactiferous duct proliferation, increase in alveoli and glandular tissue that displaces connective tissue, and increase in mammary vascularization. As a result, the breasts are larger, softer, and looser, with a blue venous network visible through the skin. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 353 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 9. Milk production usually begins during which period? a. At conception b. During the first trimester of pregnancy c. Immediately before delivery d. Two to 4 days after delivery ANS: D
Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 353 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Mrs. Kemmerer is a 56-year-old patient who presents to the office for a routine annual
examination. She states that she completed menopause 3 years ago and has not had further menses. Which breast change is typical after menopause? a. Thickening of the inframammary ridge b. Hypertrophy of glandular tissue c. Increase in number of lactiferous ducts d. Reduction of fat deposits ANS: A
After menopause, the breast tissue atrophies and is replaced by fat deposits, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 353 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. Mrs. Jones, a 45-year-old patient, comes into the office today with a complaint of a breast
lump. In a woman complaining of a breast lump, it is most important to ask about: a. its relationship to menses. b. weight gain. c. sleep patterns. d. immunization status. ANS: A
Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 353 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
12. While collecting personal and social history data from a woman complaining of breast
discomfort, you should question her regarding her: a. history of medication allergies. b. alcohol, tobacco, and caffeine use. c. level of personal education. d. amount of personal income. ANS: B
The amount of alcohol, tobacco, and caffeine use is questioned because it affects the breasts. For women with fibrocystic breasts, avoiding caffeine in coffee, tea, chocolate, and soft drinks may decrease water retention and discomfort. Women who consume two to five alcoholic drinks daily have times the risk of developing breast cancer than women who drink no alcohol. Smoking significantly increases the risk of breast cancer in women with a family history of breast and ovarian cancers. DIF: Cognitive Level: Applying (Application) REF: p. 355 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 13. Most women with breast cancer: a. possess the BRCA1 or BRCA2 gene. b. risk increases with aging. c. have a mother who had breast cancer. d. continue to menstruate after age 52. ANS: B
Of all breast cancers, 77% occur in women older than 50 years. Most women with breast cancer do not possess the BRCA1 or BRCA2 gene. Only 5% to 10% of women with breast cancer are known to have either gene. Most women with breast cancer do not have a mother who had breast cancer. Familial breast cancers occur in 10% to 20% of breast cancer populations. Most women with breast cancer do not continue to menstruate after age 52. Having a later start of menopause does not overshadow the 77% of all breast cancers that occur in women older than 50 years. DIF: Cognitive Level: Analyzing (Analysis) REF: pp. 353-354 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. A 50-year-old woman presents as a new patient. Which finding in her personal and social
history would increase her risk profile for developing breast cancer? a. Drinking three glasses of wine per week b. Early menopause c. Nulliparity d. Late menarche ANS: C
Nulliparity, or late age at the birth of the first child (after 30 years old), is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily. DIF: Cognitive Level: Applying (Application) REF: p. 354 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
15. If your patient has nipple discharge, you will most likely need a: a. Vacutainer tube. b. glass slide and fixative. c. specimen jar with formaldehyde. d. tape strip to test pH. ANS: B
A glass slide and fixative are used for microscopic examination of the discharge to identify its cellular makeup. DIF: Cognitive Level: Applying (Application) REF: p. 355 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 16. To begin the clinical breast examination (CBE) for a man, ask him to: a. recline on the table, with his arms overhead. b. sit with his arms hanging at his sides. c. sit with his hands on his hips. d. stand with his arms clasped behind his back. ANS: B
Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for men and women. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 355 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Inspection of the breasts usually begins with the patient in which position? a. Lateral b. Sitting c. Standing d. Supine ANS: B
Inspection of the breasts begins with the patient in a sitting position, with the arms hanging loosely at the sides. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 355 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 18. While examining a 30-year-old woman, you note that one breast is slightly larger than the
other. In response to this finding, you should: a. note the finding in the patient’s record. b. ask the patient if she has ever had breast cancer. c. tell the patient to get a mammogram as soon as possible. d. tell the patient to get a mammary sonogram as soon as possible. ANS: A
Often one breast is slightly larger than the other. This is a normal variation and no further intervention is required. DIF: Cognitive Level: Applying (Application)
REF: p. 355
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Reduction of Risk Potential
19. Which finding, on inspection, is related to fibrotic tissue changes that occur with breast
carcinoma? a. Convex or conical shape b. Skin dimpling or retraction c. Pendulous and loose breasts d. Unequal shape or contour ANS: B
Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 356 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 20. Venous patterns on breasts are suggestive of pathology when they are: a. bilaterally visible. b. seen in obese patients. c. unilateral. d. observed during pregnancy. ANS: C
Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 356 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 21. Which of the following is a common benign variation in the breasts of a pregnant woman? a. Unilateral leakage of bloody fluid b. Bilateral leakage of bloody fluid c. Bilateral pronounced venous patterns d. Reddened areas in the tail of Spence ANS: C
Bilateral venous patterns on the breast are commonly found in pregnant or obese women and are of no clinical concern. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 356 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A 23-year-old white woman has come to the clinic because she has missed two menstrual
periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your response to this finding is to: a. instruct her that this is a side effect of birth control injection therapy. b. suggest pregnancy testing. c. question her use of tanning beds. d. schedule an appointment with a surgeon. ANS: B
In light-skinned women, pregnancy produces enlarged breasts with a darker areola. Neither hormonal injections nor the use of tanning beds will change the color of the areola as does pregnancy. Surgical consultation is not necessary. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 364 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 23. In patients with breast cancer, peau d’orange skin is often first evident: a. in the axilla. b. in the upper inner quadrant. c. on or around the nipple. d. at the inframammary ridge. ANS: C
The areola is the most common initial site for visualization of peau d’orange skin. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 356 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 24. A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a: a. normal finding. b. sign of carcinoma. c. skin disease. d. symptom of malnutrition. ANS: A
Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 356 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Which of the following is most likely to be a variation of minor consequence? a. Bilateral nipple inversion b. Fixed stonelike nodule c. Serous nipple drainage d. Unequal nipple axis ANS: A
Bilateral nipple inversion to the same extent on both breasts is not a concern. A fixed stone like a nodule, serous nipple drainage, and an unequal nipple axis are results of cancer growth. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 356-357 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 26. Recent unilateral inversion of a previously everted nipple suggests: a. mastitis. b. cancer. c. benign breast disease. d. pregnancy. ANS: B
Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy, rather than a benign condition. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 357 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 27. Which condition is more common in African American women than in white women? a. Light areolae b. Nipple inversion c. Retracted areolae d. Supernumerary nipples ANS: D
The incidence of supernumerary nipples is higher in African American women than in white women. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 357 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 28. Documentation of a breast mass location is done: a. according to illustration, without a narrative. b. according to clock positions from the nipple. c. by measuring with calipers from the nipple. d. by measuring in centimeters from the sternal notch. ANS: B
Documentation of a breast mass location is done according to clock positions and distance from the nipple or according to quadrants of the breast. An illustration should appear in the medical record as well. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 361 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 29. A firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-
year-old patient’s breast. You should: a. ask the patient if she has a history of breast cancer. b. refer the patient to a surgeon. c. ask the patient to have a mammogram as soon as possible. d. record the finding in the patient’s record. ANS: D
The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding, without indications for further action. DIF: Cognitive Level: Applying (Application) REF: p. 363 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 30. The tail of Spence extends: a. into the midclavicular region. b. toward the supraclavicular area. c. down into the inframammary ridge. d. into the axillae.
ANS: D
The tail of Spence extends from the upper outer breast quadrant into the axillae. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 31. To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine,
with: a. her arms straight alongside of her body. b. both arms overhead with palms upward. c. her hands clasped just above the umbilicus. d. one arm overhead and a pillow under her shoulder. ANS: D
Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 360 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 32. Palpation of the nipple is done by: a. compressing it between the thumb and forefinger. b. pressing it against the rib cage. c. pulling it outward and releasing it. d. rolling it in a clockwise motion. ANS: A
At the completion of a breast examination, the nipple is compressed by using two fingers gently (normally the thumb and first finger) to depress the tissue inward. Nipple compression to evoke discharge is no longer part of the clinical breast examination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 361 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 33. When examining axillary lymph nodes, the patient’s arm is: a. raised fully above the head. b. extended at the side. c. flexed at the elbow. d. crossed over the chest. ANS: C
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla. DIF: Cognitive Level: Applying (Application) REF: p. 360 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 34. Lymphatic flow of the breast primarily drains: a. toward the abdomen. b. to the corresponding arm. c. radially.
d. across toward the sternum. ANS: C
The primary direction of lymphatic flow of the breast is radially and deeply to the underlying lymphatics. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 352 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 35. You are performing a clinical breast examination for a 55-year-old woman. While palpating
the supraclavicular area, you suspect that you feel a node. To improve your hooked technique, you should: a. apply lotion to your hands. b. use both hands simultaneously. c. ask the patient to press both palms together. d. ask the patient to turn her head toward that side. ANS: D
Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa. DIF: Cognitive Level: Applying (Application) REF: p. 360 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 36. Male gynecomastia associated with illicit or prescription drug use can be expected to: a. lessen when the body becomes accustomed to the drug. b. resolve after the drug is discontinued. c. leave permanent breast enlargement when the drug is discontinued. d. cause purulent drainage if left untreated. ANS: B
Gynecomastia associated with illicit or prescription drug use (e.g., antihypertensive drugs, estrogens, steroids) usually resolves after the offending drug is discontinued and does not require further intervention. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 365 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 37. A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythemic
breasts bilaterally. You should advise the patient to: a. massage gently and continue nursing. b. apply warm compresses and stop nursing. c. monitor her temperature and restrict fluids. d. sleep wearing a bra and wash her breasts with antibacterial soap. ANS: A
This patient has mastitis. The aim of treatment is to promote breast drainage. You should not advise the patient to apply warm compresses and stop nursing. Applying warm compresses will not encourage breast milk flow, and stopping nursing will increase the risk of a breast infection turning into a breast abscess. Monitoring her temperature and restricting fluids do not encourage breast milk flow. Sleeping with a bra and washing the breasts with antibacterial soap do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 365 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 38. You are conducting a clinical breast examination for your 30-year-old patient. Her breasts are
symmetric, with bilateral, multiple tender masses that are freely moveable and with welldefined borders. You recognize that these symptoms and assessment findings are consistent with: a. Fibroadenoma b. Paget disease c. Cancer d. Fibrocystic changes ANS: D
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, welldelineated borders. A fibroadenoma is usually nontender. Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Cancer is usually nontender. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 365 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 39. Your patient is a nursing mother who asks you to look at a mole she has under her left breast
at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed: a. Montgomery tubercle. b. case of Paget disease. c. supernumerary nipple. d. fat necrosis. ANS: C
Supernumerary nipples usually resemble moles and occur, as this one does, along the milk line. Those that have glandular tissue may enlarge under hormonal influences. They may not be recognized as extra nipples in infants because they are usually small and not well formed. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 357 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 40. When conducting a clinical breast examination, the examiner should: a. forgo the examination if the patient has had a recent mammogram. b. keep the patient's breasts completely covered to respect modesty. c. dim the lights to minimize anxiety. d. inspect both breasts simultaneously. ANS: D
Simultaneous observation of both breasts is essential to detect differences between breast size, symmetry, contour, and skin color. DIF: Cognitive Level: Applying (Application) REF: p. 355 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Mrs. Weber is a 65-year-old patient who has presented at the clinic with a complaint of a
tender breast mass that she discovered during breast self-examination. You have completed a physical examination on Mrs. Weber and have palpated a mass of the right breast in the lower outer quadrant. When providing patient education to Mrs. Weber regarding the breast mass, you will explain that the characteristics of a cancerous mass would be which of the following? (Select all that apply.) a. Immobile and firm b. Pain on palpation c. Irregular border edges d. Mobile and rubbery e. Nontender ANS: A, C, E
Characteristics of cancerous breast masses are irregular or stellate, hard, fixed, nontender, and poorly delineated. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 366 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Ms. Lawson is a 41-year-old patient who presents for a routine annual examination. During
her breast examination, you are also completing a lymphatic examination. Which of the following lymph nodes are examined during a breast examination? (Select all that apply.) a. Supraclavicular b. Lateral axillary nodes c. Anterior cervical nodes d. Anterior axillary nodes e. Posterior cervical nodes ANS: A, B, D DIF: Cognitive Level: Remembering (Knowledge) REF: p. 360 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 3. Which of the following muscles form the floor of the breast? (Select all that apply.) a. Pectoralis major b. Pectoralis minor c. Serratus posterior d. Internal oblique e. Rectus abdominis ANS: A, B, E
The muscles that form the floor of the breast are the pectoralis major, pectoralis minor, serratus anterior, latissimus dorsi, subscapularis, external oblique, and rectus abdominis.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 351 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential COMPLETION 1. The greatest concern for breast cancer is when you palpate _______________ nodes. ANS:
supraclavicular The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 360 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. When palpating breast tissue, the examiner should use ______________ at each site. ANS:
finger pads, gliding Finger pads are used for breast palpation because they are more sensitive than the fingertips. The finger pads should glide from one point to the next, avoiding lifting of the finger off the breast tissue. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 361 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Reduction of Risk Potential
Chapter 17: Abdomen Test Bank—Nursing MULTIPLE CHOICE 1. A serous membrane that lines the abdominal cavity and forms a protective cover for many
abdominal structures is the: a. peritoneum. b. mediastinum. c. periosteum. d. hilum. ANS: A
The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 370 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. Duodenum b. Ileum c. Jejunum d. Pylorus ANS: A
The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. ANS: C
The movement of food and digestive products is regulated by the autonomic nervous system. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The esophagus travels a route from: a. behind the trachea through the mediastinal cavity. b. lateral to the trachea through the diaphragm. c. left of the trachea through the peritoneum. d. the anterior trachea through the cardiac orifice. ANS: A
The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters the stomach. The esophagus connects the pharynx to the stomach. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Which of the following organs is part of the alimentary tract? a. Pancreas b. Stomach c. Gallbladder d. Liver ANS: B
The term alimentary tract refers to the continuous tract from the mouth to the esophagus, stomach, small intestine, large intestine, and anus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 370; 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The most superior part of the stomach is the: a. body. b. fundus. c. pylorus. d. pyloric orifice. ANS: B
The most superior aspect of the stomach is the fundus, followed by the body and then the most distal part, the pylorus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Which of the following is true regarding the stomach? a. It lies in the lower right quadrant of the abdomen. b. It secretes gastric lipase, which digests protein. c. Very little absorption takes place in the stomach. d. The stomach produces most of the body’s bile. ANS: C
The stomach has a very small role in the absorption of nutrients. The stomach lies across the upper abdomen, not in the lower right quadrant. The stomach secretes gastric lipase, but gastric lipase does not digest protein. The stomach does not produce most of the body’s bile. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The appendix is an extension of the: a. stomach. b. pancreas. c. small intestine. d. large intestine.
ANS: D
The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. When palpating the abdomen, you should note whether the liver is enlarged in the: a. left lower quadrant. b. midepigastric region. c. periumbilical area. d. right upper quadrant. ANS: D
The liver is located in the right upper quadrant of the abdomen. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. ANS: C
The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 373 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Most nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon. ANS: B
Most absorption takes place in the small intestine. Very little absorption takes place in the stomach. The cecum and transverse colon are part of the large intestine, and their major function is water resorption. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption.
d. glucose storage. ANS: A
The major function of the large intestine is the absorption of water and excretion of solid waste materials in the form of stool. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 372 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of
the: a. gallbladder. b. kidney. c. liver. d. pancreas. ANS: C
The liver is responsible for converting fat-soluble waste to water-soluble materials so that the kidneys can excrete them and convert ammonia to urea. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 373 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Contraction of the gallbladder propels bile into the: a. stomach. b. duodenum. c. jejunum. d. large intestine. ANS: B
With contraction of the gallbladder, bile is excreted into the duodenum. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 373 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Which organs have both an excretion function and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Pancreas and kidney d. Gallbladder and pancreas ANS: C
The pancreas excretes pancreatic juices and produces insulin and glucagons; the kidneys excrete urine and produce rennin and erythropoietin. Although the kidneys excrete urine and function as an endocrine gland, the gallbladder is an excretory organ that is not considered an endocrine gland. The liver and gallbladder are excretory organs and are not considered endocrine glands. Although the pancreas excretes pancreatic juices and produces insulin and glucagons, the gallbladder is an excretory organ that is not considered an endocrine gland. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 373 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
16. The major occupant of the retroperitoneal space is the: a. kidneys. b. lungs. c. spleen. d. bladder. ANS: A
The kidneys occupy most of the retroperitoneal space, lying behind the abdominal cavity, beside the abdominal aorta. The lungs and bladder lie outside the peritoneum, but not in the retroperitoneal area. The spleen is within the peritoneum. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 373 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Mrs. James is 7 months pregnant and states that she has developed a problem with
constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as: a. decreased movement through the colon and increased water absorption from the stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and fewer nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. ANS: A
Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. Movement through the colon is decreased during pregnancy. The colon does not absorb nutrients. A tighter sphincter tone is not related to pregnancy. DIF: Cognitive Level: Applying (Application) REF: p. 374 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased saliva secretion. c. decreased bile absorption. d. decreased motility. ANS: D
Motility of the intestine is the most pronounced GI change in older adults. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 375 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. The family history of a patient with diarrhea and abdominal pain should include inquiry about
cystic fibrosis because it is: a. a common genetic disorder. b. one cause of malabsorption syndrome. c. a curable condition with medical intervention. d. the most frequent cause of diarrhea in general practice. ANS: B
Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent complaints. DIF: Cognitive Level: Applying (Application) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. When assessing abdominal pain in a college-age woman, one must include: a. history of interstate travel. b. food likes and dislikes. c. age at completion of toilet training. d. the first day of the last menstrual period. ANS: D
Exploring abdominal pain complaints in a young woman can reveal multiple causes related to the menstrual cycle, including menstrual pain, ovulation discomfort, and abnormal menses. Asking the patient to tell you the first day of her last menstrual period can help discriminate among these factors. History of international travel and traveler’s diarrhea can be related to abdominal pain, but interstate travel usually does not. Food preferences and age at completion of toilet training are not relevant. DIF: Cognitive Level: Applying (Application) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. pancreatitis. ANS: B
Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that cause destruction of the bowel, and it becomes more apparent after feedings. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Inspection of the abdomen should begin with the patient supine and the examiner: a. seated at the patient’s side. b. standing at the foot of the table. c. standing at the patient’s left. d. walking around the table. ANS: A
Being seated at the patient’s side is the preferred initial position because it allows tangential viewing of the abdomen for improved assessment of abdominal contour. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
23. Before performing an abdominal examination, the examiner should: a. ascertain the patient’s HIV status. b. have the patient empty his or her bladder. c. don double gloves. d. completely disrobe the patient. ANS: B
The patient should empty the bladder to ensure an accurate examination of organs and provide comfort for the patient. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach ANS: A
The hypogastric (pubic) area contains the ileum, bladder, and pregnant uterus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 379 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. You are completing a general physical examination on Mr. Rock, a 39-year-old man with
complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. ANS: C
To help relax the abdominal musculature, it is helpful to place a small pillow under the patient’s head and under slightly flexed knees. The other techniques are not helpful because they increase muscle flexion. DIF: Cognitive Level: Applying (Application) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever.
During your examination, you ask the patient to raise her head and shoulders while she lies in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. ANS: D
A diastasis recti occurs when the abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and usually occurs in women who have had repeated pregnancies and in obese patients. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Integrated Process: Communication and Documentation
REF: p. 374
27. After thorough inspection of the abdomen, the next assessment step is: a. percussion. b. palpation. c. auscultation. d. rectal examination. ANS: C
Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence occurs because palpation and percussion can alter the frequency and intensity of bowel sounds. Therefore, auscultation is done first. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint
of constipation. During auscultation, you note borborygmi sounds. This is associated with: a. gastroenteritis. b. peritonitis. c. satiety. d. paralytic ileus. ANS: A
Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as does hunger. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Peritonitis produces bowel sounds that are: a. hypoactive. b. hyperactive. c. high-pitched. d. absent. ANS: A
Hypoactive bowel sounds occur with peritonitis and paralytic ileus. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 382 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. To document absent bowel sounds correctly, one must listen continuously for: a. 30 seconds. b. 1 minute.
c. 3 minutes. d. 5 minutes. ANS: D
Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the
correct technique for locating the: a. descending aorta. b. lower liver border. c. medial border of the spleen. d. upper right kidney ridge. ANS: B
Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border of more than 2 to 3 cm signifies hepatomegaly. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. When auscultating the abdomen, which finding would indicate collateral circulation between
the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Venous hum ANS: D
Venous hum is associated with blood flow in the venous collaterals, as found in portal hypertension. Aortic bruit occurs during systole, whereas a venous hum is a continuous sound and softer than a bruit. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants. ANS: D
Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. When percussing a spleen, Traube’s space is a:
a. b. c. d.
semilunar region. splenic percussion sign. left-sided pleural effusion. solid mass.
ANS: A
Percussion of the spleen is more difficult because percussion tones elicited may be caused by other conditions. Traube’s space is a semilunar region defined by the sixth ribs superiorly, the midaxillary line laterally, and the left costal margin inferiorly. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 383 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back
and left scapula, with nausea and vomiting. Based on this history, your prioritized physical examination should be to: a. percuss for ascites. b. assess for rebound tenderness. c. inspect for ecchymosis of the flank. d. auscultate for abdominal bruits. ANS: C
Abdominal pain that radiates to the back could be caused by pancreatitis or a gastric ulcer, gallbladder pain usually radiates to the right or left scapula but not to the back, pancreatitis pain can radiate to the left shoulder or scapula, and nausea and vomiting usually occur with gallbladder, pancreas, or appendix conditions. Pancreatitis is a differential diagnosis for all these symptoms, so begin the examination by inspecting the flanks for the Grey Turner sign, an indication of pancreatitis. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 390 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. To assess for liver enlargement in the obese person, you should: a. use the hook method. b. have the patient lean over at the waist. c. auscultate using the scratch technique. d. attempt palpation during deep exhalation. ANS: C
If the abdomen is obese or distended, or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver. DIF: Cognitive Level: Applying (Application) REF: p. 386 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. ANS: C
Expect two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally close spontaneously by 2 years, and pulsations to the abdomen in the epigastric area are common. DIF: Cognitive Level: Applying (Application) REF: p. 393 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Failure to pass a meconium stool in the first 24 hours after birth, along with abdominal
distention, are often the first signs of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. ANS: B
Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. DIF: Cognitive Level: Applying (Application) REF: p. 377 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. When palpating the aorta, a prominent lateral pulsation suggests: a. an aortic aneurysm. b. normal pulsation. c. a renal artery fistula. d. a vena cava varicosity. ANS: A
Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition? a. Positive psoas sign b. Positive McBurney sign c. Consistent right lower quadrant (RLQ) pain d. Rebound tenderness ANS: C
A positive psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the RLQ are signs of appendicitis. The absence of pain migration makes appendicitis less likely. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 390 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. When using the bimanual technique for palpating the abdomen, you should: a. push down with the bottom hand and the other hand on top. b. push down with the top hand and concentrate on sensation with the bottom hand.
c. place the hands side by side and push equally. d. place one hand anteriorly and the other hand posteriorly, squeezing the hands
together. ANS: B
The bimanual technique uses one hand on top of the other. Exert pressure with the top hand while concentrating on sensation with the other hand. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 384 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. A 23-year-old man comes to the urgent care clinic with intense left flank and lower left
quadrant pain. A patient response to a history of present illness questions that further supports a tentative diagnosis of renal calculi is which of the following? a. “My urine has been a bright yellow.” b. “I have had fever and chills for 2 days.” c. “I also have a headache and neck ache.” d. “My left testicle and shoulder hurt as well.” ANS: D
Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder). DIF: Cognitive Level: Analyzing (Analysis) REF: p. 409 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. Which of the following is the most useful adjunct to the history of present illness when
assessing the quantity and degree of a patient’s abdominal pain? a. Appetite and recall of last meal b. Family comments about the patient c. Patient’s previous medical record d. Finding abdominal scars ANS: A
Inquiring about hunger and eating patterns is an important indicator. It is unlikely that hunger will persist with an acute intraabdominal infection. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 375 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings usually
associated with: a. diverticulitis. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. ANS: A
Only diverticulitis has all these presenting symptoms. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 403 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
45. A 51-year-old woman calls with complaints of weight loss and constipation. She reports
enlarged hemorrhoids and rectal bleeding. You advise her to: a. use a topical, over the counter hemorrhoid treatment for 1 week. b. exercise and eat more fiber. c. come to the laboratory for a stool guaiac test. d. eat six small meals a day. ANS: C
Blood in the stool is an abnormal finding that should never be ignored, even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 404 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. A patient presents to the emergency department after a motor vehicle accident. The patient
sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. Which organ is most likely injured? a. Gallbladder b. Liver c. Spleen d. Stomach ANS: C
Spleen laceration or rupture is always suspected with abdominal injury because of the spleen’s anatomic location. The patient’s presenting symptoms confirm this suspicion. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 407 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. Costovertebral angle tenderness should be assessed whenever you suspect that the patient may
have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. ANS: C
Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. DIF: Cognitive Level: Applying (Application) REF: p. 408 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. pyloric stenosis. c. intussusception. d. Meckel diverticulum. ANS: D
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 412 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A
sausage-shaped mass is palpable in his right upper quadrant. Joe’s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe’s symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis ANS: A
Intussusception refers to the prolapse of one segment of the intestine into another, causing intestinal obstruction. A sausage-shaped mass may be palpated in the right or left upper quadrant, whereas the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 410 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she
fastens the child’s diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n): a. fixed mass palpated in the hypogastric area. b. tender, midline abdominal mass. c. olive-sized mass of the right upper quadrant. d. nontender, slightly movable, flank mass. ANS: D
A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension, fever, malaise, and a firm nontender mass deep within the flank that is only slightly movable and is usually unilateral. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 413 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 51. In older adults, overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. fecal impaction. d. fistula formation. ANS: C
Constipation with overflow occurs when the rectum contains hard stool and soft feces above a leak around the mass of stool. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 415 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 52. When examining the abdomen, what is the first examination technique used?
a. b. c. d.
Inspection Light palpation Percussion Auscultation
ANS: A
Inspection is always used as the first technique in all stages of the physical examination, including the abdomen. In the abdomen, the auscultation is completed prior to percussion or palpation. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Urinary incontinence that occurs from the inability to hold urine once the stimulus to urinate
is perceived is called _____ incontinence. ANS:
urge Urge incontinence is the inability to delay urination once the urge to void occurs. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 415 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. You are examining the abdomen of a 45-year-old female patient. When percussing her urine-
filled bladder, you will hear _______________ tones. ANS:
dull percussion Dullness is heard over organs and solid masses. A distended bladder produces dullness in the suprapubic area. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 381 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Your patient is a 48-year-old woman with complaints of severe cramping pain in the abdomen
and right flank. Her past medical history includes a history of bladder calculi. You diagnose her with renal calculi at this time. Which of the following symptoms would you expect with her diagnosis? (Select all that apply.) a. Abdominal pain on palpation b. Blumberg sign c. Cullen sign d. CVA tenderness e. Fever f. Grey Turner sign
g. Hematuria h. Nausea ANS: A, D, E, G
Abdominal pain on palpation, CVA tenderness, fever, hematuria, and nausea are all signs and symptoms of renal calculi. The Cullen sign is ecchymosis around the umbilicus, the Blumberg sign is rebound tenderness for appendicitis, the Grey Turner sign is ecchymosis in the flanks, and the McBurney sign is rebound tenderness at McBurney’s point. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 409 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential 2. Your patient returns to the office with multiple complaints regarding her abdomen. Which of
the following are objective findings? (Select all that apply.) a. Nausea b. dullness on percussion c. rebound tenderness d. Vomiting e. Diarrhea f. burning pain in epigastrium ANS: B, C, E, F
Nausea, vomiting and diarrhea, and burning pain in epigastrium are subjective signs. Dullness on percussion and rebound tenderness are objective findings. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 409 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Reduction of Risk Potential
Chapter 18: Female Genitalia Test Bank—Nursing 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) REF: p. 417 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) REF: p. 431 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Which structure is located posteriorly on each side of the vaginal orifice? a. Skene glands b. Clitoris c. Perineum d. Bartholin glands ANS: D
Bartholin glands are found posteriorly on each side of the vaginal orifice. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 417 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. During sexual excitement, how is the vaginal introitus lubricated? a. The Bartholin glands secrete mucus. b. The clitoris produces moisture. c. The Skene glands drain fluid. d. The urethral surfaces secrete water. ANS: A
The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 417 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) REF: p. 418 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) REF: p. 419 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) REF: p. 423 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) REF: p. 423 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) REF: p. 423 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) REF: p. 423 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Which systemic feature is related to the effects of menopause? a. Increased abdominal fat distribution b. Decreased LDL levels c. Cold intolerance d. Decreased cholesterol levels ANS: A
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 423 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 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? a. Bowel habits b. Douching routines c. Menstrual flow d. Nutritional factors 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) REF: p. 427 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Which risk factor is associated with cervical cancer? a. Endometriosis b. Low parity c. Multiple sex partners d. Obesity ANS: C
Cervical cancer is associated with certain HPV strains. Multiple sex partners increase the risk of HPV infection. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 425 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) REF: p. 425 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) REF: p. 426 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 soaps, 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) REF: p. 441 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. The female patient should ideally be in which position for the pelvic examination? a. Fowler b. Prone c. Lateral supine d. Lithotomy ANS: D
Ideally, the woman should be in a lithotomy position for a pelvic examination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 428 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) REF: p. 431 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Which of the following findings indicates a possible gonococcal infection? a. Bulging of the anterior or posterior vaginal wall b. Discharge from urethra or Skene glands c. Irregular urethral orifice in midline d. Irregular vaginal edges at introitus ANS: B
When milking the Skene glands produces a discharge, it is usually a gonococcal infection. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 429 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. The examiner should change gloves after touching the patient’s: a. anal area. b. Bartholin glands.
c. Skene glands. d. urethra. ANS: A
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 435 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. During a digital examination of the vagina, the cervix is noted to be positioned posteriorly. On
bimanual examination of this woman, you would expect to palpate a(n) ___________ uterus. a. retroverted b. anteverted c. midline d. laterally deviated ANS: B
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 431 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. The presence of cervical motion tenderness may indicate: a. pregnancy. b. nulliparity. c. pelvic inflammatory disease. d. vulvovaginitis. ANS: C
Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 436 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Which one of the following is a proper technique for the use of a speculum during a vaginal
examination? 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. 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) REF: pp. 430-431 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
24. Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You
should: a. chart this as nabothian cysts. b. chart this as a friable cervix. c. obtain a viral culture. d. test the pH of the cervical os. ANS: A
This describes nabothian cysts, which are retention cysts of the endocervical glands that are considered a normal variant. No further testing is warranted. A friable cervix describes one that is red and bleeds easily. You would not obtain a viral culture or test the pH of the cervical os. DIF: Cognitive Level: Applying (Application) REF: p. 431 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. An examiner has rotated a brush several times into the cervical os. The brush was withdrawn
and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection? a. Gonococcal culture b. Cytology smear c. Haemophilus smear d. Trichomonas smear ANS: B
This describes the technique for obtaining a Pap smear for cytologic examination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 434 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When collecting specimens, which sample should be obtained first? a. Chlamydial swab b. Gonococcal culture c. Pap smear d. Wet mount 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) REF: p. 434 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Dacron swabs are necessary when testing for which condition? a. Gonorrhea b. Pregnancy c. Trichomoniasis d. Chlamydia
ANS: D
Dacron swabs are necessary when testing for chlamydia. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 434 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. The visualization of a large proportion of clue cells on your wet mount slide examination
suggests: a. trichomonal infection. b. bacterial vaginosis. c. candidiasis. d. gonorrhea. ANS: B
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagellae are present in trichomonal infection. Gonorrhea cannot be identified on a wet mount. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 435 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. 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) REF: p. 435 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Bimanual examination of the uterus includes: a. grasping the cervix between the examining fingers. b. grasping the vaginal wall and pulling it downward. c. inserting one finger into the fundus. d. placing the thumb on the clitoris and the forefinger on the cervix. ANS: A
The bimanual examination includes testing for cervical motion tenderness by grasping the cervix between the examining fingers and moving from side to side. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 436 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. The assessment of which structure is not part of the bimanual examination? a. Cervix b. Bladder c. Uterus d. Ovaries
ANS: B
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 436-437 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. The rectovaginal examination is an important component of the total pelvic examination
because it: a. is the most direct cervical examination route. b. is a more comfortable examination for the posthysterectomy patient. c. is an alternate source for cytology specimens. d. allows the examiner to reach almost 2.5 cm higher into the pelvis. ANS: D
The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 438 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Prominent labia minora are a normal finding in: a. adolescents. b. menopausal women. c. newborns. d. pregnant women. ANS: C
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 439 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. Swollen and bruised genitalia in a newborn are most likely related to: a. a breech delivery. b. a congenital defect. c. an infection. d. maternal hormones. ANS: A
Although the genitalia of the newborn girl can be swollen due to maternal hormones, swelling and bruising are more likely caused by a breech delivery. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 439 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. 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) REF: p. 441 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. 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) REF: p. 440 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. 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) REF: p. 441 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Young women who are not sexually active should have their first pelvic examination: a. by age 15 years. b. by age 18 years. c. by age 21 years. d. only after they become sexually active. ANS: C
Young women who are not sexually active should have their first examination by the age of 21. DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 437
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
39. During a pelvic examination for a postmenopausal woman, you would expect to assess: a. a wider and longer vaginal vault. b. the absence of vaginal wall rugation. c. a nonpalpable cervical os. d. a more mobile cervix. ANS: B
Expected findings in the pelvic examination of an older woman include a narrower and shorter vagina, the absence of rugation, a less mobile cervix, and a palpable cervical os. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 447 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. What accommodations should be used for the position of a hearing-impaired woman for a
pelvic examination? 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. 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) REF: p. 449 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. 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 be inspected without squeezing. DIF: Cognitive Level: Applying (Application) REF: p. 423 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. 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) REF: p. 454 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Physiologic Adaptation 43. Which of the following is a normal component of vaginal discharge seen on a wet mount? a. Three to five white blood cells (WBCs) b. Clue cells c. Motile flagellates d. Spores and hyphae ANS: A
Up to three to five WBCs on a wet mount are within normal limits. Clue cells, motile flagellates, and spores and hyphae are not normal components of vaginal discharge seen on a wet mount. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 457 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Physiologic Adaptation 44. The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is: a. homogeneous and gray, with a low pH. b. scant and curdy, with a low pH. c. profuse and frothy, with a high pH. d. profuse and curdy, with a low pH. ANS: C
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal < 4.5). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 457 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Physiologic Adaptation 45. 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 is 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) REF: p. 461 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. The opening of the cervix is referred to as the: a. anterior fornix.
b. pouch of Douglas. c. cervical isthmus. d. cervical os. ANS: D
The uterus opens into the vagina at the cervical os. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 419 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Prolonged menses is usually defined as bleeding for more than _____ days. ANS:
7 Menses is considered prolonged if it lasts longer than 7 days. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 451 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A fixed uterus may indicate ______________. ANS:
adhesions The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 437 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Softening of the uterine isthmus occurring between 6 and 8 weeks of pregnancy is the
_________ sign. ANS:
Hegar Between the sixth and eighth weeks of pregnancy, the uterine isthmus softens; this is known as the Hegar sign. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 443 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy. ANS:
20 At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 443 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 19: Male Genitalia Test Bank—Nursing MULTIPLE CHOICE 1. The movement of the testes by muscular action regulates: a. ejaculatory flow. b. sebaceous production. c. testicular temperature. d. urinary flow. ANS: C
The cremasteric muscle contracts and relaxes the scrotum. This action alters the distance of the testes from the body to cool or warm the testes. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 466 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which structure of the male genitalia travels through the inguinal canal and unites with the
seminal vesicle to form the ejaculatory duct? a. Epididymis b. Prostate gland c. Testicles d. Vas deferens ANS: D
The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Normally, the male urethral orifice is located: a. 2 mm ventral to the tip of the glans. b. on the dorsal surface of the glans. c. cephalad to the dorsal vein. d. adjacent to the prostate. ANS: A
The urethral orifice is located approximately 2 mm ventral to the tip of the glans. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 466 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. A finding associated with recurrent male genital herpes is: a. disseminated lymphadenopathy. b. pain subsiding with scrotal elevation. c. soft, red papules on the prepuce. d. superficial penile vesicles. ANS: D
Genital herpes presents as painful superficial vesicles on an erythematous base. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 478 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mr. Johnson is a 43-year-old patient who presents for a routine physical examination. On
examination, you note that the urethral meatus opens on the ventral surface of his penis. You determine that he has which condition? a. Epispadias b. Hydrocele c. Hypospadias d. Normal variation ANS: C
The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 484 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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) REF: p. 466 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Testicular temperature must be maintained lower than 37° C for which of the following to
occur? a. Penile erection b. Spermatogenesis c. Testosterone production d. Rugae to form ANS: B
The production of sperm is dependent on the maintenance of testicular temperature below the normal body temperature of 37° C (98.6° F). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 466 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) REF: p. 466 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Which of the following is the most accurate approximation of normal adult testicular size (in
centimeters)? a. 5 2 3 b. 2 3 3 c. 4 3 2 d. 5 7 7 ANS: C
The normal dimensions of the adult male testes are 4 3 2 cm. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The greatest contribution to the volume of ejaculate comes from the: a. prostate. b. epididymis. c. seminal vesicles. d. corpus cavernosa. ANS: A
The major volume of ejaculatory fluid comes from the prostate gland. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) REF: p. 472 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. How much blood usually engorges the two corpora cavernosa of the penis when it is erect? a. 5 to 15 mL b. 20 to 50 mL c. 55 to 60 mL d. More than 100 mL ANS: B
Penile erection occurs when 20 to 50 mL of blood is contained in the corpora cavernosa. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Which of the following is a risk factor for testicular cancer? a. Circumcision b. Condyloma acuminatum c. Cryptorchidism d. Poor hygiene ANS: C
Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 470 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Which of the following hernias occurs more often in females and has the lowest incidence of
occurrence? a. Indirect b. direct c. femoral d. ventral ANS: C
Femoral hernias are the least common type of hernia and occurs more often in females. Most common type of hernia is an indirect inguinal hernia. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 476 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
16. 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 examiner’s thumb and forefinger. This maneuver opens the slitlike orifice for further inspection. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 472 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Which penile structure should be visible to inspection during the physical examination? a. Dorsal vein b. Proximal urethral c. Epididymis d. Corpus cavernosa ANS: A
The dorsal vein of the penis should be evident. The others are internal structures and should not be visible. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 471 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) REF: p. 471 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Which technique is appropriate for detecting an inguinal hernia? a. Conduct percussion while the patient coughs. b. Have the patient strain as you pinch the testes. c. Inspect rectal areas as the patient bears down. d. Move your finger upward along the vas deferens. ANS: D
Inspect the groin while the patient performs a Valsalva maneuver. Insert your examination finger into the lower part of the scrotum and follow upward along the vas deferens to screen for a hernia. DIF: Cognitive Level: Applying (Application) REF: p. 473 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Which type of hernia lies within the inguinal canal? a. Umbilical b. Direct c. Indirect d. Femoral ANS: C
Hernias found within the inguinal canal are called indirect hernias. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 473 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Which one of the following conditions is of minor consequence in an adult male? a. Adhesions of the foreskin b. Continuous penile erection c. Lumps in the scrotal skin d. Venous dilation in the spermatic cord ANS: C
Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 472 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. 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) REF: p. 472 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. 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) REF: p. 473 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. 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) REF: p. 473 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. A premature infant’s scrotum will appear: 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) REF: p. 474 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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) REF: p. 475 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
27. 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) REF: p. 475 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. The most common cancer in young men aged 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, selfexamination is encouraged. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 470 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. 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) REF: p. 476 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. 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) REF: p. 482 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 31. When examining a small child, in which position should he be placed to help push the
testicles into the scrotum? a. Supine b. Tailor c. Standing d. Prone ANS: B
When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination. Placing a small child in the other positions will not help. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 475 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. 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) REF: p. 476 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. 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) REF: p. 478 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. Which genital virus infection is known to have a latent phase followed by the production of
viral DNA capsids and particles? a. Condyloma acuminatum b. Molluscum contagiosum c. Herpetic lesions
d. Lymphogranuloma venereum 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) REF: p. 479 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. 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) REF: p. 480 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. Self-examination of the male genitalia: a. should be restricted to adults with a prior cryptorchidism. b. should be performed while bathing. c. starts with palpation and then inspection. d. should be performed yearly. ANS: B
Monthly self-examination is recommended as a screening test for testicular cancer and for sexually transmitted infections for all males starting at 15 years of age. It is encouraged during bathing because the scrotal skin is thinner at this time and because the scrotum hangs looser because of the warmth. Inspection is first, followed by palpation. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 470 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 37. 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)
REF: p. 481
OBJ: Nursing process—diagnosis
MSC: Physiologic Integrity: Physiologic Adaptation
38. Which condition is a complication of mumps in the adolescent or adult? a. Cystitis b. Epididymitis c. Orchitis d. Paraphimosis ANS: C
Orchitis is uncommon unless seen as a complication of mumps in the adolescent or adult. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 482 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. 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) REF: p. 469 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. 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) REF: p. 480 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. 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)
REF: p. 474
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
COMPLETION 1. Sexual differentiation in the fetus has occurred by _____ weeks’ gestation. ANS:
12 By 12 weeks’ gestation, sexual differentiation has occurred in the fetus. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 468 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A painless indurated lesion on the glans penis is most consistent with a _________. ANS:
chancre A syphilitic chancre is a painless lesion with an indurated border and a clear base. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 478 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 20: Anus, Rectum, and Prostate Test Bank—Nursing MULTIPLE CHOICE 1. The adult internal rectal sphincter is controlled by the: a. autonomic nervous system. b. central nervous system. c. lumbar spinal reflexes. d. sacral spinal reflexes. ANS: A
The internal ring of smooth muscle of the anal canal is under involuntary autonomic control. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 485-486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The urge to defecate is caused by: a. constriction of the internal sphincter. b. the rectum filling with feces. c. cognitive processes. d. fluid volume in the stomach. ANS: B
The sensation to defecate results from the rectum filling with feces, which in turn stimulates relaxation of the internal sphincter. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The proximal end of the rectum is continuous with the: a. sigmoid colon. b. duodenum. c. ileum. d. rectal sphincter. ANS: A
Ascending from the anus is the rectum and then the sigmoid colon, which is at the proximal end of the rectum. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The mother of a 1-week-old, breast-fed baby tells you that she is concerned because her baby
has a small bowel movement each time he feeds. You should let the mother know that: a. this is normal. b. she should feed the baby less. c. this usually indicates an abnormality. d. she needs to switch the baby to formula. ANS: A
The newborn’s myelination of the spinal cord is incomplete and the internal and external sphincters are under involuntary reflexive control—that is, the gastrocolic reflex. Therefore, newborns will produce stool after each feeding. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal.
Which sign would indicate to the health care 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) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. In males, which surface of the prostate gland is accessible by digital examination? a. Median lobe b. Posterior c. Superior d. Anterior 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) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) REF: p. 586 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) REF: p. 487 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) REF: p. 489 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) REF: p. 488 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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) REF: p. 489 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Which of the following is a risk factor for colorectal cancer? a. High-fiber diet b. Diet low in animal fats and proteins c. Irish descent d. History of colonic polyps 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) REF: p. 498 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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) REF: p. 490 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) REF: p. 489 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) REF: p. 489 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) REF: pp. 490-491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Your patient’s chief complaint is repeated, 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) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Tarry black stools should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. ANS: C
Upper intestinal tract bleeding results in tarry black stools. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A 70-year-old man has a prostate-specific antigen (PSA) value of 6 ng/mL and a negative
digital rectal examination (DRE). These results indicate: a. prostatic hypertrophy. b. prostate cancer. c. internal hemorrhoids. d. a normal finding. ANS: D
The normal range for the PSA value is less than 4 ng/mL and between 4 and 10 ng/mL is borderline, with older men having normal higher levels. Considering the patient’s age, a negative DRE and borderline PSA value probably represent a normal finding. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. 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) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Which finding in an infant may indicate lower spinal deformities? a. Perirectal redness b. Shrunken buttocks c. Rectal prolapse
d. Dimpling in the pilonidal area 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) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. An infant with constipation and a consistently empty rectum may need evaluation for: a. sexual abuse. b. Hirschsprung disease. c. rectal abscess. d. intestinal parasites. ANS: B
A consistently empty rectum in the presence of constipation is a clue to the diagnosis of Hirschsprung disease. Other presentations include the failure to pass meconium in the first 24 hours. along with a gradual onset of abdominal distention and vomiting. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. A lower spinal cord lesion may be indicated by which finding? a. Lack of an anal wink b. Rectal prolapse c. Anal fistula d. Small flaps of anal skin 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) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. 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) REF: p. 492 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. A common cause of dark green or black stools during pregnancy is: a. consumption of iron preparations. b. consumption of vitamins. c. slow intestinal bleeding.
d. slow bleeding of hemorrhoids. ANS: A
The daily use of iron replacement therapy, as expected during pregnancy, results in dark green or black stools. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 493 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. An expected anal or rectal finding late in pregnancy is the presence of: a. cysts. b. hemorrhoids. c. hypertrophy. d. polyps. ANS: B
Hemorrhoids are an expected variation late in pregnancy. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 493 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. 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) REF: p. 496 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. 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) REF: p. 493 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. 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) REF: p. 499 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. Mr. Gregorio is a 38-year-old patient who presents with complaints of anal pruritus. 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) REF: p. 500 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. A healthy prostate protrudes into the rectal wall a distance of _____ cm. ANS:
less than 1 A healthy prostate should not protrude more than 1 cm into the rectum. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 486 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When performing a rectal examination in a man, the patient is placed in the ______________
position. ANS:
left lateral The male patient is usually positioned left lateral or standing, with the upper body flexed at the waist over the examination table and with the toes pointed together for increased exposure of the area. DIF: Cognitive Level: Applying (Application) REF: p. 489 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) REF: p. 491 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 21: Musculoskeletal System Test Bank—Nursing MULTIPLE CHOICE 1. Which joints are frequently moving articulations that are enclosed by a capsule of fibrous
articular cartilage? a. Synarthroses b. Synchondroses c. Amphiarthroses d. Synovial ANS: D
Synovial articulations are freely moving joints that are enclosed by a compartment made up of cartilage and ligaments. Synarthroses are immovable joints. Synchondroses are immovable joints. Amphiarthroses are slightly movable. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 501 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Fluid that lubricates articular cavities is called: a. blood. b. synovial fluid. c. mucus. d. cerumen. ANS: B
Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. Blood does not act as a lubricant. Mucus should not be found in articular cavities. Cerumen is ear wax. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 501 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Joints are held together by: a. tendons. b. ligaments. c. muscles. d. cartilage. ANS: B
Bones are held together within a joint by ligaments. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 501 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Bones are attached to muscles by: a. tendons. b. ligaments.
c. muscles. d. cartilage. ANS: A
Tendons attach muscle to bone. Ligaments attach bone to bone. Muscles are not bound together by other muscles. Cartilage helps in the production of new bone and acts as an insulator for bones in joints. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 501 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. An increase in muscle tone is known as: a. crepitus. b. effusion. c. spasticity. d. atrophy. ANS: C
An increase in muscle tone is referred to as spasticity. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 511 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The glenohumeral joint is the other name for the:
a. b. c. d.
elbow. shoulder. wrist. scapula.
ANS: B
The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and scapula. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. The cruciate ligaments of the knee provide for: a. anterior and posterior stability. b. medial and lateral stability. c. movement on one plane. d. pivoting and rotation. ANS: A
The cruciate ligaments of the knee are positioned as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 507 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. Medial and lateral surfaces of the tibiotalar joint are protected by: a. bursae. b. tendons. c. muscles. d. ligaments. ANS: D
The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 507-508 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The suprapatellar bursa separates the patella, quadriceps tendon, and muscle from the: a. tibia. b. fibula. c. femur. d. pelvis. ANS: C
The suprapatellar bursa separates the knee, quadriceps, and muscle from the femur. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 507 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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) REF: p. 507 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) REF: p. 508 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) REF: p. 508 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) REF: p. 508 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) REF: p. 509 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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) REF: p. 539 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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) REF: p. 510 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. 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) REF: p. 510 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. 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) REF: p. 510 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Pain, disease of the muscle, or damage to the motor neuron may all cause: a. bony hypertrophy. b. muscle crepitus. c. muscle hypertrophy. d. muscle wasting. ANS: D
Muscle wasting is a consequence of pain from injury, pathology of the muscle, or injury to the motor neuron. DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 510
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
24. Fasciculation occurs after injury to a muscle’s: 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) REF: p. 510 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. 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) REF: p. 510 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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) REF: p. 511 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. 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)
REF: p. 516
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
28. 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) REF: p. 516 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. The temporalis and masseter muscles are evaluated by: a. having the patient shrug their shoulders. b. having the patient clench their teeth. c. asking the patient to fully extend their neck. d. passively opening the patient’s jaw. 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) REF: p. 516 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. The strength of the trapezius muscle is evaluated by having the patient: a. clench her or his teeth during muscle palpation. b. push her or his head against the examiner’s hand. c. straighten her or his leg with examiner opposition. d. uncross her or his legs with examiner resistance. ANS: B
Having the patient apply opposite force with differing head motions, against the examiner’s hand, assesses the sternocleidomastoid and trapezius muscles. DIF: Cognitive Level: Applying (Application) REF: p. 516 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. 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
Spinal alignment is considered within normal limits when the patient’s head is positioned 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) REF: p. 516 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. 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) REF: p. 518 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. 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) REF: p. 518 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. When the patient flexes forward at the waist, which spinal observation would lead you to
suspect scoliosis? a. Prominent lumbar hump b. Prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips 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) REF: p. 519 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. 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) REF: p. 514 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. 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) REF: p. 514 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. Ulnar deviation and swan neck deformities are characteristic 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) REF: pp. 512-513 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. 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) REF: p. 513 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. 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) REF: p. 524 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Excessive hyperextension of the knee with weight bearing may indicate: a. advanced joint degeneration. b. gout. c. rotation of the Achilles tendon. d. weakness of the quadriceps muscle. ANS: D
Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 522 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Arm length is measured from the acromion process through the: a. olecranon joint to the carpal thumb hinge. b. olecranon process to the distal ulnar prominence. c. proximal radial prominence to the distal joint. d. proximal ulnar joint to the middle fingertip. ANS: B
Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow joint (olecranon process) to the wrist (distal ulnar prominence). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 529 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. A positive straight leg raise test usually indicates: a. leg length discrepancy. b. improperly conditioned muscles. c. lumbar nerve root irritation. d. hip bursitis. ANS: C
Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with their neck flexed and to raise one leg. If pain is felt, this is a positive straight leg raise. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 526 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. The Thomas test is used to detect: a. hip dislocation. b. unstable sacroiliac joints. c. knee instability. d. flexion contractures of the hip. ANS: D
The Thomas test requires the patient to lie supine, with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 426 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. Which one of the following techniques is used to detect a torn meniscus? a. Drawer test b. McMurray test c. Thomas test d. Trendelenburg test ANS: B
The McMurray test detects a meniscus tear. The drawer test detects an anterior cruciate ligament tear. The Thomas test detects hip contraction. The Trendelenburg test detects weak hip abductor muscles. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 527 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. When performing the McMurray test, the examiner should place the patient in a supine
position with a hand on the patient’s completely flexed knee and the foot flat on the table at the buttocks, and then: a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. apply valgus stress with the foot planted. d. apply varus stress with the foot planted. ANS: A
The next step is to turn the ankle outward while applying a valgus stress and then extend the knee. DIF: Cognitive Level: Applying (Application) REF: p. 527 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. Which technique is performed at every infant’s examination during the first year of life to
detect hip dislocation?
a. b. c. d.
Ballottement maneuver Barlow-Ortolani maneuver Range of motion Thomas McMurray assessment
ANS: B
At every examination during an infant’s first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation, which is signified by a clicking noise with the maneuver. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 530 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. You note that a child has a positive Gower sign. You know that this indicates generalized: a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy. ANS: B
A positive Gower sign indicates generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee and pushing down on the thighs while trying to pull the trunk up. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 532 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. A 3-year-old is brought to the clinic complaining of a painful right elbow. He is holding his
right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of: a. radial head subluxation. b. femoral anteversion. c. carpal tunnel syndrome. d. osteomyelitis. ANS: A
The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid’s elbow. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 542 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 49. What temporary disorder may be experienced by pregnant women during the third trimester
because of fluid retention? a. Carpal tunnel syndrome b. Osteitis deformans c. Radial head subluxation d. Talipes equinovarus ANS: A
Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 533 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 50. A red, hot, swollen joint in a 40-year-old man should lead you to suspect: a. trauma. b. bursitis. c. gout. d. cellulitis. ANS: C
Gout is characterized as red, hot, swollen joints, especially in the great toe. Gout is commonly found in men older than 40 years. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 536 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 51. An adult with bowed tibias and a shortened thorax may have: a. ankylosing spondylitis. b. Paget disease. c. rheumatoid arthritis. d. Sprengel deformity. ANS: B
Paget disease is characterized by bowed tibias, an asymmetric skull, a shortened chest, and susceptibility to fractures. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 536 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 52. In contrast to the patient with rheumatoid arthritis (RA), the osteoarthritis patient typically
exhibits: a. pain most pronounced after periods of rest. b. depression. c. sudden onset. d. less weakness and fatigue. ANS: D
One of the key differences between the symptoms of osteoarthritis and RA is that fatigue is uncommon in osteoarthritis patients. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 537 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 53. Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would
perform (or elicit) a: a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test.
d. tibial torsion test. ANS: B
The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm the results for a hip dislocation. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 537 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 54. Term infants normally resist: a. ankle dorsiflexion. b. McMurray test. c. forefoot adduction. d. knee extension. ANS: D
Along with elbows and hips, newborns tend to resist extension of the knee; however, their movements should be symmetric. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 530 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 55. A 7-year-old child who begins to limp and complains of persistent hip pain may have: a. congenital hip dislocation. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis. ANS: C
Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by an inadequate blood supply. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 541 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 56. Dupuytren contracture affects the: a. hip flexor muscle. b. rotator cuff. c. carpal tunnel. d. palmar fascia. ANS: D
A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 543 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 57. A dowager hump is: a. the hallmark of osteoporosis. b. pathognomic of scoliosis. c. indicative of tendonitis.
d. characteristic of rickets. ANS: A
Osteoporosis leads to vertebral compression and kyphotic bowing of the spine, known as dowager hump. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 543 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. A tingling sensation radiating from the wrist to the hand on striking the median nerve is a
positive _____ sign. ANS:
Tinel The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 524 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Anterior cruciate ligament integrity is assessed via the _________ test. ANS:
Lachman The Lachman test evaluates anterior cruciate ligament integrity. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 528 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. During a football game, a player was struck on the lateral side of the left leg while his feet
were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the __________ test. ANS:
valgus stress The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus. DIF: Cognitive Level: Applying (Application) REF: p. 524 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The elbow joint that allows for flexion and extension in one plane represents a type of _____
joint. ANS:
hinge A hinge joint allows for flexion and extension in one plane. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The most mobile vertebrae are the _______________ vertebrae. ANS:
cervical The cervical vertebrae are the most mobile because flexion and extension occur between the skull and C1. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 505 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) REF: p. 538 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The wrist moves in: (Select all that apply.) a. eversion and inversion. b. proximal radius and ulna articulation. c. flexion and extension d. adduction and abduction. 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) REF: p. 505 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 22: Neurologic System Test Bank—Nursing MULTIPLE CHOICE 1. The autonomic nervous system coordinates which of the following? a. High-level cognitive function b. Balance and affect c. Internal organs of the body d. Balance and equilibrium ANS: C
The autonomic nervous system coordinates the internal environment of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex; its function consists of determining intelligence, personality, and motor function. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 544 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The major function of the sympathetic nervous system is to: a. orchestrate the stress response. b. coordinate fine motor movement. c. determine proprioception. d. perceive stereognosis. ANS: A
Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for emergencies for fight or flight (stress response). The cerebellum plays a key role in the coordination of fine motor movements. Recognition of body parts and awareness of body position (proprioception) are dependent on the parietal lobe. Stereognosis is the ability to perceive the weight and form of solid objects by touch and is not under sympathetic control. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 544 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The parasympathetic nervous system maintains the day-to-day function of: a. digestion. b. response to stress. c. lymphatic supply to the brain. d. lymphatic drainage of the brain. ANS: A
The parasympathetic division functions in a complementary and counterbalancing manner to conserve body resources and maintain day to day body functions, such as digestion and elimination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 544 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Cerebrospinal fluid serves as a:
a. b. c. d.
nerve impulse transmitter. red blood cell conveyer. shock absorber. mediator of voluntary skeletal movement.
ANS: C
Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 545 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Diabetic peripheral neuropathy will likely produce: a. hyperactive ankle reflexes. b. diminished pain sensation. c. exaggerated vibratory sense. d. hypersensitive temperature perception. ANS: B
Peripheral neuropathy is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, usually in the hands and feet. Patients may have sensations of numbness, tingling, burning, and cramping. In moderate to severe diabetic neuropathy, there is wasting of the foot muscles, absent ankle and knee reflexes, decreased or no vibratory sensation below the knees, and/or loss of pain or sharp touch sensation to the midcalf level. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 565 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The thalamus is the major integration center for the perception of: a. speech. b. olfaction. c. pain. d. thoughts. ANS: C
The thalamus is the major integrating center for the perception of various sensations such as pain and temperature, serving as the relay center between the basal ganglia and cerebellum. The reception of speech and interpretation of speech are located in the Wernicke area. The olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to plan, and enables you to imagine and think. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 546 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The awareness of body position is known as: a. proprioception. b. graphesthesia. c. stereognosis. d. two-point discrimination. ANS: A
Recognition of body parts and awareness of body position are known as proprioception. This is dependent on the parietal lobe. The other options are assessment techniques that test for sensory impairment. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 546 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Which area of the brain is responsible for perceiving sounds and determining their source? a. Frontal lobe b. Occipital lobe c. Parietal lobe d. Temporal lobe ANS: D
The temporal lobe is responsible for the perception and interpretation of sounds and determination of their source. The frontal lobe contains the motor cortex associated with voluntary skeletal movement. The occipital lobe contains the primary vision center. The parietal lobe is primarily responsible for processing received sensory data. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 546 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Peripheral nerves that arise from the brain rather than the spinal cord are called ___________
nerves. a. sympathetic b. parasympathetic c. cranial d. autonomic ANS: C
Cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord. The other choices refer to the autonomic nervous system. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 547 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Which area of the brain maintains temperature control? a. Epithalamus b. Thalamus c. Abducens d. Hypothalamus ANS: D
The hypothalamus is the major processing center of internal stimuli for the autonomic nervous system. It maintains temperature control, water metabolism, body fluid osmolarity, feeding behavior, and neuroendocrine activity. The epithalamus houses the pineal body and is responsible for sexual development and behavior. The thalamus conveys all sensory impulses, except olfaction, to and from the cerebrum before their distribution to appropriate associative sensory areas. The abducens is the sixth cranial nerve with motor function responsible for lateral eye movement. DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 547
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
11. If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN)
requires further evaluation? a. CN I, olfactory b. CN V, trigeminal c. CN IX, glossopharyngeal d. CN XI, spinal accessory ANS: D
CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with smell reception and interpretation. CN V is associated with opening of the jaw, chewing, and sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex, taste, secretion of salivary glands, carotid reflex, and swallowing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 547 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Motor maturation proceeds in an orderly progression from: a. peripheral to central. b. head to toe. c. lateral to medial. d. pedal to cephalic. ANS: B
Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck develops first, followed by the trunk and extremities. The other choices are incorrect because they relate the maturation sequence inappropriately, from outward to central. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 549 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Normal changes of the aging brain include: a. increased velocity of nerve conduction. b. diminished perception of touch. c. increased total number of neurons. d. diminished intelligence quotient. ANS: B
Sensory perceptions of touch and pain are diminished by aging. The velocity of nerve impulse conduction declines, so responses to stimuli take longer. The number of cerebral neurons is thought to decrease by 1% a year, beginning at 50 years of age; however, the vast number of reserve cells inhibits the appearance of clinical signs. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 549 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. The area of body surface innervated by a particular spinal nerve is called a: a. dermatome. b. nerve pathway. c. spinal accessory area.
d. cutaneous zone. ANS: A
The sensory and motor fibers of each spinal nerve supply and receive information to a segment of skin known as a dermatome. Nerve pathway and spinal accessory area refer to nerve routes. Cutaneous zone refers to a skin area that transmits fine mechanical information and normal exogenous thermal information at the same time. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 549 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. A neurologic past medical history should include data about: a. allergies. b. circulatory problems. c. educational level. d. immunizations. ANS: B
The neurologic past medical history should include data concerning neurovascular problems such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical information for the neurologic past medical history. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 551 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Which of the following is the technique most often used for evaluating the neurologic system? a. Auscultation b. Inspection c. Palpation d. Percussion ANS: B
The evaluation tool of inspection is used most often. Inspection of gait and response to questions can provide data concerning neurologic system function. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 552 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. When assessing superficial pain, touch, vibration, and position perceptions, you are testing: a. cerebellar function. b. emotional status. c. sensory function. d. tendon reflexes. ANS: C
Superficial pain, touch, vibration, and position perceptions are sensory functions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 552 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. You are initially evaluating the equilibrium of Ms. Q. You ask her to stand, with her feet
together and arms at her sides. She loses her balance. Ms. Q has a positive:
a. b. c. d.
Kernig sign. Homan sign. McMurray test. Romberg sign.
ANS: D
The Romberg test has the patient stand with the eyes closed, feet together, and arms at the sides. A slight swaying movement of the body is expected, but not to the extent of falling. Loss of balance results in a positive Romberg test. The Kernig sign indicates meningeal irritation, the Homan sign indicates venous thrombosis, and the McMurray test is a rotation test for demonstrating a torn meniscus. DIF: Cognitive Level: Applying (Application) REF: p. 559 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. The finger to nose test allows assessment of: a. coordination and fine motor function. b. point location. c. sensory function. d. stereognosis. ANS: A
To perform the finger to nose test, the patient closes both eyes and touches his or her nose with the index finger, alternating hands while gradually increasing the speed. This tests coordination and fine motor skills. All the other choices test sensory function without motor function. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 557 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. You are performing a two-point discrimination test as part of a well physical examination. The
area with the ability to discern two points in the shortest distance is the: a. back. b. palms. c. fingertips. d. upper arms. ANS: C
The fingertips can discern two points with a minimal distance of 2 to 8 mm, the back, 40 to 70 mm, the palms, 8 to 12 mm, and the upper arms, 75 mm. DIF: Cognitive Level: Applying (Application) REF: p. 562 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to
side while swaying his trunk. You would document Mr. B’s pattern as: a. dystonic ataxia. b. cerebellar ataxia. c. steppage gait. d. tabetic stamping. ANS: B
A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide-based, with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk. Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar-flexed foot off the ground. The foot is brought down with a slap and the patient is unable to walk on the heels. Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 560 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 22. Deep pressure tests are used mostly for patients who are experiencing: a. absent superficial pain sensation. b. gait and stepping disturbances. c. lordosis, osteoporosis, or arthritis. d. tonic neck or torso spasms. ANS: A
Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle, thus causing discomfort. When superficial pain sensation is not intact, further assessments of temperature and deep pressure sensation are performed. DIF: Cognitive Level: Applying (Application) REF: p. 561 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 23. Vibratory sensory testing should be routinely done for the patient with: a. Parkinson disease. b. diabetes. c. cerebral palsy. d. Guillain-Barré syndrome. ANS: B
Diabetic neuropathy must be routinely assessed in all diabetic patients. In moderate to severe cases, decreased or absent vibratory sensation occurs below the knees, which should be assessed with a tuning fork. The other choices do not result in sensation deficits. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 561 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 24. To assess a cremasteric reflex, the nurse strokes the: a. sole of the foot and observes whether the toes fan down and out. b. abdomen and observes whether the umbilicus moves away from the stimulus. c. inner thigh and observes whether the testicle and scrotum rise on the stroked side. d. palm and observes whether the fingers attempt to grasp. ANS: C
Stroking the inner thigh of a male patient (proximal to distal) will elicit the cremasteric reflex. The testicle and scrotum rise on the stroked side. Stroking the sole of the foot elicits a Babinski sign. Stroking the abdomen elicits an abdominal reflex. Stroking the palm elicits a palmar grasp. DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 552-563
OBJ: Nursing process—assessment
MSC: Safe and Effective Care: Management of Care
25. When you ask a patient to close her or his eyes and identify an object placed in the hand, you
are evaluating: a. stereognosis. b. graphesthesia. c. vibratory sensation. d. extinction phenomenon. ANS: A
Stereognosis is the ability to recognize an object through touch and manipulation. Tactile agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion. Graphesthesia tests the patient’s ability to identify the figure being drawn on the palm. The vibratory sense uses a tuning fork placed on a bony prominence, and the extinction phenomenon tests sensation by simultaneously touching bilateral sides of the body with a sterile needle. DIF: Cognitive Level: Applying (Application) REF: p. 562 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 26. The ability to recognize a number traced on the skin is called: a. stereognosis. b. graphesthesia. c. an extinction phenomenon. d. two-point discrimination. ANS: B
The ability to recognize a number traced on the skin is called graphesthesia. Stereognosis is the ability to recognize an object through touch and manipulation. The extinction phenomenon test and two-point discrimination assess a person’s ability to discern the number of pinpoints and their location. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 562 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 27. Which one of the following conditions is consistent with Brown-Séquard syndrome? a. Central sensory loss that is generalized b. Motor paralysis on the lesion side of the body c. Multiple peripheral neuropathy of the joints d. Spinal root paralysis below the umbilicus ANS: B
Parietal spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and temperature sensation occur one to two dermatomes below the lesion on the opposite side of the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of the body. DIF: Cognitive Level: Applying (Application) REF: p. 562 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 28. To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested? a. Triceps
b. Patellar c. Biceps d. Achilles ANS: B
To assess spinal levels L2-L4, the patellar reflex should be tested. The patellar tendon is the only deep tendon that assesses the lumbar spinal level. The triceps and biceps tendon are tested to assess the cervical spine, whereas the Achilles tendon is tested to assess the sacral spine. DIF: Cognitive Level: Applying (Application) REF: p. 563 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 29. When using a monofilament to assess sensory function, the nurse: a. uses two simultaneous monofilaments on similar bilateral points and then
compares results. b. applies both a monofilament and a pin on similar bilateral points and then
compares results. c. applies pressure to the monofilament until the filament bends. d. strokes the monofilament along the skin from proximal to distal areas. ANS: C
The monofilament is placed on several smooth spots of the patient’s plantar foot for seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament. DIF: Cognitive Level: Applying (Application) REF: p. 565 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 30. Visible or palpable extension of the elbow is caused by reflex contraction of which muscle? a. Achilles b. Biceps c. Patellar d. Triceps ANS: D
The triceps tendon, when directly hit with the reflex hammer just above the elbow, will cause contraction of the triceps muscle and extension of the elbow. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 564 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 31. It is especially important to test for ankle clonus if: a. deep tendon reflexes are hyperactive. b. deep tendon reflexes are hypoactive. c. the Romberg sign is positive. d. the patient has peripheral neuropathy. ANS: A
Test the ankle clonus when reflexes are hyperactive. Support the patient’s knee in a flexed position and briskly dorsiflex the foot with your other hand. If clonus is present, there is recurrent ankle plantar flexion movement as long as the examiner retains the foot in dorsiflexion. Sustained clonus signifies the hypertonia of an upper motor neuron lesion. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 565 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 32. Which sign is associated with meningitis and intracranial hemorrhage? a. Babinski sign b. Asymmetric tonic neck reflex c. Doll’s eye movement d. Nuchal rigidity ANS: D
A stiff neck or nuchal rigidity is a sign associated with meningitis and intracranial hemorrhage. Test this by lifting the head of the patient to touch the chin while the patient lies in a supine position. Pain and resistance to neck motion are associated with nuchal rigidity. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 565 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 33. When assessing a 17-year-old for nuchal rigidity, you gently raise his head off the
examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test, you would also perform a test for the __________ sign. a. Kernig b. Babinski c. obturator d. Brudzinski ANS: A
The first action elicited the Brudzinski sign. This sign is an indicator of meningeal irritation. To confirm meningeal irritation, you would test for the Kerning sign, also a meningeal sign. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 566 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 34. On a scale of 1+ to 4+, which deep tendon reflex score is appropriate for a finding of clonus in
a patient? a. 1+ b. 2+ c. 3+ d. 4+ ANS: D
1+ indicates a sluggish or diminished reflex. 2+ indicates an active or expected response. 3+ indicates more brisk than expected, slightly hyperactive. 4+ indicates brisk, hyperactive, with intermittent or transient clonus. DIF: Cognitive Level: Applying (Application) REF: p. 564 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care
35. Cranial nerve XII may be assessed in an infant by: a. watching the infant’s facial expressions when crying. b. observing the infant suck and swallow. c. clapping hands and watching the infant blink. d. observing the infant’s rooting reflex. ANS: B
Cranial nerve (CN) XII may be assessed in an infant by observing the infant suck and swallow, by pinching the nose, and then observing for the mouth to open and the tip of the tongue to rise in a midline position. Watching the infant’s facial expressions when crying assesses CN VII. Clapping hands and watching the infant blink tests CN VIII. Observing the rooting reflex assesses CN V. DIF: Cognitive Level: Applying (Application) REF: p. 567 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 36. You are most concerned for the infant who has a: a. weak palmar grasp at 3 months. b. strong stepping reflex at 2 months. c. weak plantar reflex at 9 months. d. strong tonic neck at 6 months. ANS: D
The tonic neck reflex must disappear before the infant can roll over or bring his or her hands to their face; it should disappear by 6 months. The other choices are within expected ranges. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 568 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 37. At what age should the infant begin to transfer objects from hand to hand? a. 2 months b. 4 months c. 7 months d. 10 months ANS: C
Transferring objects hand to hand begins at 7 months. Purposeful release of objects is noted as a normal finding by 10 months. Purposeful movements, such as reaching and grasping for objects, begin at about 2 months of age. The progress of taking objects with one hand begins at 6 months. There should be no tremors or constant overshooting of movements. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 566 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 38. An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14
days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is: a. cerebral palsy. b. HIV encephalopathy. c. Guillain-Barré syndrome. d. Rett syndrome.
ANS: C
Guillain-Barré syndrome—acute idiopathic polyneuritis—is an acute polyradiculoneuropathy that commonly follows a nonspecific infection that occurred 10 to 14 days earlier. It is characterized by ascending symmetric weakness with sensation preserved. An increase in severity occurs over days or weeks. A decrease in or absent strength and sensory loss may result, along with motor paralysis and respiratory muscle failure. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 577 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 39. Which of the following is a concern, rather than an expected finding, in older adults? a. Reduced ability to differentiate colors b. Bilateral pill-rolling of the fingers c. Absent plantar reflex d. Reduction in upward gaze ANS: B
Bilateral pill-rolling is indicative of Parkinson disease; the other choices are expected findings with aging. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 579 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 40. Which of the following conditions is potentially life-threatening if not treated expeditiously
with antibiotics? a. HIV encephalopathy b. Dementia c. Parkinson disease d. Bacterial meningitis ANS: D
Meningitis is an inflammatory process in the meninges. Bacterial meningitis is a lifethreatening illness if not rapidly treated with appropriate antibiotics. All the other diseases are neurologic disorders not treatable by antibiotics. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 566 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 41. Ipsilateral Horner syndrome indicates a cerebrovascular accident (CVA) occurring in the: a. anterior portion of the pons. b. internal or middle cerebral artery. c. posterior inferior cerebellar artery. d. vertebral or basilar arteries. ANS: C
The posterior inferior cerebellar artery supplies the lateral and posterior portion of the medulla. A CVA involving this artery can produce a neurologic sign of ipsilateral Horner syndrome in the eye. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 576 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care
42. The immune system attacks the synaptic junction between the nerve and muscle fibers,
blocking acetylcholine receptor sites in: a. myasthenia gravis. b. encephalitis. c. multiple sclerosis. d. cerebral palsy. ANS: A
Myasthenia gravis is a chronic autoimmune neuromuscular disease involving the lower motor neurons and muscle fibers. The immune system of infected individuals produces antibodies that destroy acetylcholine receptor sites at the neuromuscular junction. This blocks the nerve impulse from reaching the muscle and produces muscle fatigue. Encephalitis is acute inflammation of the brain and spinal cord involving the meninges. It is often caused by a virus, such as the herpes simplex virus. Multiple sclerosis is a progressive autoimmune disorder characterized by a combination of inflammation and degeneration of the myelin in the brain’s white matter, leading to obstructed transmission of nerve impulses and decreased brain mass. Cerebral palsy is a permanent disorder of movement and posture development associated with nonprogressive (static) disturbances that occurred in the developing fetal or infant brain. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 576 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 43. Persons with Parkinson disease have an altered gait characterized by: a. short shuffling steps. b. the trunk in a backward position. c. exaggerated swinging of the arms. d. lifting the legs in a high-stepping fashion. ANS: A
The altered gait of Parkinson disease has short shuffling steps, the posture is stooped forward, and the arms have limited swing. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 580 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care COMPLETION 1. You are assessing the deep tendon reflexes of a 28-year-old man. Your examination reveals
that the patient’s reflexes are normal. You would document this finding as _____. ANS:
2+ Deep tendon reflexes are scored as follows: 0: No response 1+: Sluggish or diminished 2+: Active or expected response 3+: More brisk than expected, slightly hyperactive 4+: Brisk, hyperactive, with intermittent or transient clonus
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Safe and Effective Care: Management of Care
REF: p. 564
2. The motor cortex of the brain is in the _______________. ANS:
frontal lobe The frontal lobe contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 546 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care 3. The major portion of brain growth and myelinization occurs between ____ and ____ year(s)
old. ANS:
birth; 1 The major portion of brain growth, along with myelinization of the brain and nervous system, occurs in the first year of life. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 549 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care MULTIPLE RESPONSE 1. The tests for cortical sensory function include which of the following? (Select all that apply.) a. Two-point discrimination b. Extinction phenomenon c. Superficial pain d. Stereognosis e. Touch ANS: A, B, D
The following tests are tests for cortical sensory function—stereognosis, two-point discrimination, extinction phenomenon, graphesthesia, and point location. DIF: Cognitive Level: Remembering (Knowledge) REF: pp. 561-562 OBJ: Nursing process—assessment MSC: Safe and Effective Care: Management of Care
Chapter 23: Sports Participation Evaluation Test Bank—Nursing MULTIPLE CHOICE 1. The goals of preparticipation sports evaluation include: a. screening for steroid use or abuse. b. determining the best fit for positions in each sport. c. determining the risk of injury or death during sports participation. d. securing a legal contract before recommending limiting participation. ANS: C
The ultimate goal of preparticipation physical evaluation is to ensure safe participation in an appropriate sports activity. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 581 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 2. The checkout station for preparticipation physical evaluation is critical because at this point: a. all completed forms are distributed. b. parental signatures are obtained. c. the relevant history is obtained. d. the coordination of follow-ups is reviewed. ANS: D
At the checkout station, data collected during the evaluation are reviewed and necessary follow-up actions are shared with the athlete and/or parents. In addition, the written report is distributed. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 581 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 3. You are conducting a preparticipation physical examination for a 10-year-old girl with Down
syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. Which additional diagnostic test would be required for her? a. Cervical spine radiography b. Visual acuity c. Mini-Mental State Examination d. Nerve conduction studies ANS: A
This girl is experiencing symptoms of atlantoaxial joint instability and should therefore have cervical spine radiography with neurologic consultation before beginning sports activities. DIF: Cognitive Level: Applying (Application) REF: p. 582 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 4. Part of the screening orthopedic component of the examination includes evaluating the person
while he or she is: a. performing push-ups. b. duck walking.
c. twisting at the waist. d. crossing the arms over the chest. ANS: B
Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 587 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 5. Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress
fracture. You should question this patient about her: a. sleep patterns. b. salt intake. c. aerobic workouts. d. menstrual cycles. ANS: D
The lean body encourages a hypoestrogenic state that can lead to menstrual dysfunction and osteopenia or osteoporosis. This state increases the risk of stress fractures. The patient should be questioned about amenorrhea. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 593 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 6. One of the most important aspects to consider in the orthopedic screening examination is: a. muscle contraction. b. flexibility. c. symmetry. d. balance. ANS: C
The most important aspects to consider when conducting an orthopedic examination are symmetry of muscle, stature, and joint movement. DIF: Cognitive Level: Applying (Application) REF: p. 586 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 7. Which medical condition would exclude a person from sports participation? a. Asthma b. Fever c. Controlled seizures d. HIV-positive status ANS: B
Fever can increase cardiopulmonary effort and impair exercise capacity; fever can indicate myocarditis or other infections that make exercise dangerous. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 583 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance
8. A parent is advised to restrict contact sports participation for their child. An example of a sport
in which this child could participate is: a. hockey. b. roller skating. c. riflery. d. skateboarding. ANS: C
Riflery is a noncontact sport. Hockey is considered a collision sport. Roller skating and skateboarding are considered to be limited contact sports. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 587 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 9. A child has a poorly controlled seizure disorder. He has restricted sports participation but
would be able to engage in: a. archery. b. swimming. c. weight lifting. d. badminton. ANS: D
Badminton does not pose an added risk to self or others if the child experiences a seizure during participation. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 587 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance 10. You are auscultating heart tones as part of a sports physical examination. You hear a murmur
at the right second intercostal space (aortic area). The murmur increases in intensity when this teenager goes from a sitting to standing position. The subsequent recommendation should be to: a. consult a cardiologist as soon as possible. b. have a stress test before completion of the form. c. participate in low-static, high-dynamic sports. d. limit contact sports and have an echocardiogram. ANS: A
The murmur of aortic stenosis is indicative of hypertrophic cardiomyopathy, which may be the cause of sudden death in children and adolescents at rest or during exercise. Therefore, a cardiology consult should be requested as soon as possible. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 583 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Why should the preparticipation sports examination take place well in advance of the planned
sports activity? (Select all that apply.) a. To allow completion of therapy for identified problems b. Because routine health maintenance needs to be addressed
c. Because it should be 6 weeks prior to the planned sports event d. To allow completion of follow-up testing ANS: A, D
The preparticipation sports examination should be completed well enough in advance of the planned sports activity so that rehabilitation or therapy for any problems can be completed, as well as any follow-up testing or referrals. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 581 OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance
Chapter 24: Putting it all Together Test Bank—Nursing MULTIPLE CHOICE 1. Which of the following is true regarding the relationship between the examiner and patient? a. It is the examiner’s responsibility to help the patient understand that he or she is
qualified to make decisions regarding health care. b. The patient must trust the examiner completely. c. The examiner-patient relationship is enhanced by ignoring cultural issues. d. The patient is a full partner with the examiner. ANS: D
The patient is a full partner with the examiner. The examiner should keep the patient informed and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not ignored. The examiner should keep the patient informed, but it is not the examiner’s responsibility to help the patient understand that he or she is qualified to make health care decisions. The examiner should develop a relationship to ensure trust, but it is not necessary for the patient to trust the examiner completely. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 494 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 2. Which one of the following examiner behaviors would help minimize your patient’s
dissatisfaction? a. Assume a busy and rushed attitude. b. Convey your own feelings of discomfort. c. Keep the patient waiting for more than 30 minutes. d. Seek information about the patient’s problem. ANS: D
When performing an examination, you are seeking information about the patient and the problem that brings the patient to you. This process teaches you about the patient and teaches the patient about your personal discipline, professional composure, and respect for others. DIF: Cognitive Level: Applying (Application) REF: p. 594 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 3. An examiner might be able to help a patient who seems uncomfortable with close contact
during an examination by: a. acknowledging the discomfort. b. backing away from the patient. c. joking about the patient’s discomfort. d. moving briskly to completion. ANS: A
Acknowledging the patient’s discomfort during the examination will help the patient feel more relaxed. Your professional concern can be reassuring to the patient. You should explain what you are doing to the patient before the assessment and what the patient will experience; if not, you will run the risk of losing trust. The other choices would make the patient more uneasy. DIF: Cognitive Level: Applying (Application) REF: p. 595 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 4. When performing a history and physical assessment, the examiner should: a. change the sequence of observation with each interview. b. develop a sequence of standard observations. c. develop a preliminary diagnosis at the onset. d. direct patient responses to fit the history sequence. ANS: B
When performing a history and physical assessment, you should develop an approach that is comfortable to you and ensures comfort for the patient. Part of the history can be obtained while you are doing the physical examination. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 595 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 5. The examiner should develop a demeanor that is exemplified by which one of the following
behaviors? a. Exhibits visible distaste about the condition b. Gives immediate reassurances to the patient c. Gives patient unsolicited advice d. Validates the patient’s justified concerns ANS: D
The examiner needs to learn a gentle and balanced demeanor. By showing concern for the patient’s feelings, you gain the patient’s trust; giving unsolicited advice can cause the patient to lose trust in the relationship. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 594 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 6. At your first meeting with a patient, it is usually best to say: a. “Let’s get to the point.” b. “I hope you will learn to trust me.” c. “Let me tell you what I can do for you.” d. “Tell me about yourself.” ANS: D
Take the time to ask open-ended questions to ensure that the patient has the opportunity to report accurately. Too great an adherence to routine may prevent the true story from emerging. The other statements are not open-ended, which would not allow the patient to elaborate. In addition, they are not comforting statements and would make the patient feel uncomfortable at the initial meeting. DIF: Cognitive Level: Applying (Application)
REF: p. 594
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Basic Care and Comfort
7. Which one of the following patient characteristics is most likely to limit patient reliability
during history taking? a. The patient’s measured IQ is above average. b. The patient is alert and oriented to time and place. c. The patient is sleep- and sensory-deprived. d. The patient speaks the same language as examiner. ANS: C
A partial or total loss of any of the senses can limit a patient’s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient’s ability to be a thorough historian. All the other options would not limit a patient’s reliability. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 595 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 8. Which of the following is most likely to enhance examiner reliability? a. The examiner attempts to qualify data. b. The examiner is uncomfortable with his or her own skills. c. The examiner believes that he or she must always be correct. d. The examiner prejudges the patient and family. ANS: A
As the examiner, you may not always be correct, but questioning yourself and seeking confirmation from others when necessary will serve to assure your reliability. Showing that you are uncomfortable with your skills can make the patient feel uncomfortable and see you as unreliable. Believing that you must always be correct will not enhance your reliability as an examiner. A person should never be prejudged, because this can interfere with the examination and findings. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 594 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 9. The reliability of health-related findings and observations is the responsibility of the: a. patient. b. professional and medical assistants. c. attending physician. d. professional and the patient. ANS: D
It is the responsibility of the health professional and patient to present reliable findings and observations. They work as a team. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 594 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 10. Which of the following statements accurately reflects the sensitivity and specificity of
laboratory tests? a. The gold standard test has 100% sensitivity and specificity. b. Sensitivity and specificity are inversely correlated.
c. Sensitivity and specificity are directly correlated. d. No test has 100% sensitivity and specificity. ANS: D
No test has 100% sensitivity and specificity. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 596 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 11. As you greet the patient, which examination technique is first implemented? a. Auscultation b. Inspection c. Measurement d. Palpation ANS: B
Begin to inspect the patient as you greet him or her as you look for signs of distress or disease. Inspect the appearance, gait, orientation, and difficulty in hearing or speech. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 597 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 12. Which of the following data are not part of your general inspection? a. Dress and habitus b. Sinus tenderness c. Gait d. Facial expression ANS: B
On meeting the patient, the facial expression, gait, dress, and habitus should be inspected. Inspecting for sinus tenderness is performed afterward, if indicated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 597 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 13. The sequence of the physical examination should be individualized to: a. minimize the number of times that the patient must change positions. b. maximize the convenience of the examiner. c. improve patient flow. d. minimize the time that the patient is in the room. ANS: A
There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient’s energy. DIF: Cognitive Level: Applying (Application) REF: p. 596 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 14. According to the usual examination procedure, you would first assist your patient to assume
which position? a. Lithotomy
b. Prone c. Sitting d. Supine ANS: C
On entering the examination room, you should assist the patient in the sitting position on the examining table. In the sitting position, you can examine the patient’s anterior and posterior upper trunk and head, which comprise most of the focused assessments. DIF: Cognitive Level: Applying (Application) REF: pp. 597-598 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 15. An ophthalmoscopic eye examination involves: a. lens inspection. b. near vision evaluation. c. sclera observation. d. visual field assessment. ANS: A
Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 598 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 16. Palpation of the epitrochlear nodes is part of the: a. examination of the upper extremities. b. assessment of the chest and thorax. c. palpation of the abdomen. d. examination of the head and neck. ANS: A
Palpation of the epitrochlear nodes is part of the examination of the upper extremities. To palpate the epitrochlear nodes, support the elbow in one hand and palpate in the depression above and posterior to the medial condyle of the humerus. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 598 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 17. Which of the following are examined with the patient in a reclining 45-degree position? a. Bilateral hips and popliteal angles b. Facial bones and cranial nerves V and VII c. Jugular venous pulsation and pressure d. Oropharynx and thyroid gland placement ANS: C
With the patient in a reclining 45-degree position, you can examine jugular venous pulsations and measure jugular venous pressure. All the other choices can be examined with the patient in a sitting position. DIF: Cognitive Level: Applying (Application)
REF: pp. 599-600
OBJ: Nursing process—assessment
MSC: Physiologic Integrity: Basic Care and Comfort
18. Which patient position facilitates inspection of the chest and shoulders? a. Sitting b. Supine c. Trendelenburg d. Prone ANS: A
With the patient in the sitting position, the examiner can inspect the chest and shoulders. The area being inspected is exposed for the examiner to do a thorough assessment. The other positions are not used to assess the chest and shoulders. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 598-599 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 19. When assessing the abdomen, the examiner needs to expose the patient: a. from the waist down. b. from the pubis to the epigastrium. c. in entirety. d. at no point during the examination. ANS: B
While the patient is in the supine position, the examiner can assess the abdomen. Arrange draping to expose the abdomen from the pubis to epigastrium, ensuring that the private areas of the patient are covered. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 600 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 20. To inspect the abdominal muscles, ask the: a. supine patient to raise their head. b. standing patient to bend forward. c. prone patient to raise their lower legs. d. standing patient to stand on tiptoes. ANS: A
Asking the supine patient to raise their head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. DIF: Cognitive Level: Applying (Application) REF: p. 600 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 21. Proprioception should be assessed while the patient is: a. prone. b. supine. c. seated. d. standing. ANS: D
The proprioception examination involves the Romberg test, heel to toe walking, standing on one foot and then the other with the eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 601 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 22. Examination of the patient in the lithotomy, or knee-chest, position includes: a. inspection for inguinal hernias. b. palpation of anal sphincter tone. c. percussion of pelvic structures. d. stereognosis testing. ANS: B
With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform a rectal examination to assess and palpate anal sphincter tone. The other choices require the patient to be in the supine or standing position. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 601-602 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 23. Which portion of the physical examination is best done with the patient standing? a. Spinal b. Rectal c. Neurologic d. Musculoskeletal ANS: A
With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and can also test a patient’s range of motion. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 601 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 24. The greatest risk for potential health problems occurs in which age group? a. Newborn b. Toddler c. School-age d. Adolescence ANS: A
Newborns have a greater risk for potential health problems than other age groups but also have the potential for better health than the other age groups. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 602 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 25. A common method for estimating gestational age of a newborn is to assess: a. middle finger length. b. creases on the sole of the foot. c. umbilical placement. d. visual acuity.
ANS: B
To determine gestational age, look at the soles of the feet. Before 36 weeks’ gestation, only one or two transverse creases are present; by 40 weeks’ gestation, many creases are present on the soles of the feet. Other clues to gestational age include a breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 602 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 26. To promote a child’s cooperation during your examination, your approach to the examination
should be to: a. ask the parent to give the child a bottle during the examination. b. sing songs with the child during the examination. c. conduct the physical examination on the child while the parent is holding the child. d. let the child play with examination room equipment to feel more comfortable. ANS: C
For children, the examination sequence depends on their cooperation for as long as possible. To promote this, examine the child while the parent is holding the child, which maximizes inspection and opportunities for physical examination. DIF: Cognitive Level: Applying (Application) REF: p. 603 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 27. Which of the following cannot be assessed in the crying infant: a. Tactile fremitus b. Respiratory rate c. Lung excursion d. Facial symmetry ANS: B
Respirations cannot be counted in the crying infant. Tactile fremitus can be felt when the infant is crying. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 602-603 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 28. The Ballard Gestational Age Test is completed within 36 hours of birth to: a. determine if the menstrual estimated age is correct. b. determine if the newborn is premature. c. determine an actual quantitative measure. d. combined objective and subjective observations. ANS: B
Because menstrual histories are inaccurate, the Ballard Gestational Age assessment tool contains newborn characteristics that can determine prematurity. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 602 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort
29. Mrs. Kia has brought her newborn infant in for a 2-week examination. The examination of the
newborn should begin with: a. inspection. b. palpation. c. vital signs. d. auscultation. ANS: A
The examination of a newborn should begin with inspection; skin color, flaccidity, tension, gross deformities, or distortions of faces should be noted. All the other examination techniques follow inspection. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 602 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 30. The best way to ease the apprehension of a 3-year-old child before a physical examination is
to: a. b. c. d.
explain that you will be gentle. hand the child a picture book. let the child hold the stethoscope while you listen. tell the child that he or she will get a lollipop for good behavior.
ANS: C
The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the end piece of the stethoscope or to “blow out” your flashlight. DIF: Cognitive Level: Applying (Application) REF: p. 605 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 31. In crying infants, it is often difficult to: a. perform tactile fremitus assessments. b. determine lung expansion. c. auscultate heart sounds. d. visualize the pharynx. ANS: C
For the crying infant, lungs can be auscultated between consolable moments. While the infant is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Each time a breath is taken, heart tone can be auscultated. DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 602-603 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 32. When you attempt to move a 10-month-old child from his mother’s lap to the examination
table, he screams loudly. Your best action is to: a. move the child to the examination table and proceed matter of factly with the examination. b. ask the mother to try to get the child to stop crying. c. perform the examination while the child is in the mother’s lap. d. defer the examination until another day.
ANS: C
The parent’s lap is a great examination table because it helps the child feel more at ease and is also a good way to observe the nature of the parent-child relationship. All the other actions would not comfort the patient or make the situation better. DIF: Cognitive Level: Applying (Application) REF: p. 605 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 33. When conducting a geriatric assessment, keep in mind that basic activities of daily living
(ADLs) include: a. bathing. b. housekeeping. c. medication compliance. d. communication skills. ANS: A
Basic ADLs include bathing, dressing, toileting, ambulating, and feeding. All the other options represent instrumental ADLs. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 608 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 34. When interviewing a disabled patient, it is best to speak to: a. the patient’s attendant. b. family members. c. an interpreter. d. the patient directly. ANS: D
You should speak directly with a disabled patient before addressing others. You may need to clarify responses with the patient or personal aide. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 597 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 35. Functional assessment is most important during the examination of a(n): a. adolescent. b. infant. c. older adult. d. young adult. ANS: C
Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual’s independent functional capacity. Attention should be given to self-care activities and instrumental activities. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 608 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort
36. Which of the following factors is not known to affect patient compliance with his or her
treatment regimen? a. The patient’s ability to understand the problem b. The value the patient places on resolving the problem c. The provider’s relationship with the patient d. The patient’s age and social status ANS: D
The patient’s age and social status are not known to affect compliance with the treatment regimen. The controlling factors of compliance include the nature of the relationship you have developed, your recognition of the patient’s autonomy, your success in communicating the basics of the patient’s condition, and the clarity of your instructions. Always ask the patient to repeat the instructions to you to make sure that they are understood. Equally important are the patient’s ability to understand the problem and the value that the patient places on resolving the problem. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 609 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 37. When a patient has not been compliant with instructions, an examiner should: a. ask someone else to repeat the instructions. b. explain that compliance is important. c. look for the reason behind the noncompliance. d. reprimand the patient for wasting your time. ANS: C
When a patient is not compliant with instructions, you should ask the patient to repeat the instructions to you to ensure that the instructions are understood. This can help you discover whether there is a compliance problem. DIF: Cognitive Level: Applying (Application) REF: p. 595 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 38. Observation of the child playing in the playroom provides information about which two
systems? a. Dermatologic and cardiovascular b. Neurologic and musculoskeletal c. Respiratory and ear, nose, and throat d. Gastrointestinal and genitourinary ANS: B
The child playing on the floor offers an opportunity to evaluate the musculoskeletal and neurologic systems by noting the child’s coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping. DIF: Cognitive Level: Applying (Application) REF: p. 606 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 39. Throughout the history and physical examination, the clinician should: a. concentrate on emotional issues. b. follow an inflexible sequence. c. evaluate the whole patient.
d. deal only with previously identified problems. ANS: C
The clinician should evaluate the whole patient, including physical, emotional, and social needs. Learning how to follow a disciplined course and be flexible will help the clinician during the history and physical examination. The information obtained should be kept organized to provide essential patient care. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 594 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 40. For a routine physical examination, all the following equipment is necessary except: a. a penlight. b. a measuring tape. c. examination gloves. d. a monofilament. ANS: D
A penlight, measuring tape, and exam gloves are needed for every routine examination; a monofilament is not. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 595 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 41. The cranial nerves are usually assessed while the patient is in which position? a. Standing b. Supine c. Sitting d. Prone ANS: C
While the patient is in the sitting position, you can assess all cranial nerve functions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 598 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort COMPLETION 1. Mrs. Jones is a 44-year-old patient who presents for a routine physical examination. The
patient is unable to shrug her shoulders against the examiner’s hands during the examination. The cranial nerve involved with successful shoulder shrugging is CN ____. ANS:
XI Cranial nerve XI enables the patient to shrug her shoulders. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 598 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort
Chapter 25: Taking the Next Steps: Critical Thinking Test Bank—Nursing MULTIPLE CHOICE 1. In practice, the use of evidence: a. disciplines intuitive responses. b. replaces intuitive responses. c. makes intuitive responses inconsequential. d. affirms intuitive responses. ANS: A
Your best intuitive responses are valuable in making clinical judgments; however, they must be modified in light of evidence from research and best practices that have undergone critical review prior to publication. DIF: Cognitive Level: Applying (Application) REF: p. 610 OBJ: Nursing process—evaluating MSC: Safe and Effective Care: Management of Care 2. After the subjective and objective data have been prioritized, the next step is to: a. order laboratory tests. b. formulate a problem list. c. initiate appropriate referrals. d. initiate therapy. ANS: B
After the data have been prioritized, the next step is to begin a management plan. The first step is to formulate a problem list. This step is similar to the step in the nursing process when nursing diagnoses are identified and prioritized. Ordering tests, making referrals, or initiating therapy comes after the problem list. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 610 OBJ: Nursing process—evaluating MSC: Safe and Effective Care: Management of Care 3. New findings of unknown causes are: a. problems to be noted on the problem list. b. deferred for subsequent visits. c. diagnosed before physical examination. d. reserved for specialists. ANS: A
New findings of unknown causes are added to the problem list, but do not let them become a red herring that distracts your attention from the central issues. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 610 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 4. Which of the following is an accepted method of making a diagnosis? a. Relying on intuition b. Making maximal use of laboratory tests c. Using first assumptions
d. Using algorithms ANS: D
Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 611 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 5. The adage that “common problems occur commonly” advises the practitioner to: a. always diagnose the patient’s problem in terms of what their practice usually sees. b. refer any uncommon complaints to specialists as soon as possible. c. consider the most likely cause of the patient’s problem before considering the
obscure. d. examine uncommon problems critically before assuming that the issue is an
unusual presentation of a common problem. ANS: C
This adage is to guide the practitioner to pay attention to unexpected or unusual findings but not to allow the critical review lead one astray from the central issue. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 611 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 6. The most important guide to sequencing actions should be: a. probability and utility. b. assumption and intuition. c. costs and risks of procedures. d. reimbursement potential and patient acceptance. ANS: A
Although all choices are relevant, the prioritized guide is to select actions based on an estimate of the probability of successfully achieving the patient’s goals and on the utility of implementation. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 611 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 7. Examiner experience should result in: a. the ability to analyze data with more confidence. b. reliance on intuition. c. an ability to order more laboratory tests. d. the need to spend more time with patients. ANS: A
Experience gives more confidence, resulting in greater skills at being able to analyze, evaluate, and synthesize information about the chief complaint and then arrive at a diagnosis. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 610 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care
8. LG, age 58 years, has a chief complaint of diffuse, crampy abdominal pain, which has
progressed to a severity scale of 7 of 10. He is afebrile and denies nausea, vomiting and diarrhea. Family history is positive for intestinal polyps, diabetes mellitus, and Alzheimer disease. His past medical history is positive for kidney stones, gastroesophageal reflux disease, and hypercholesterolemia. The physical examination is positive for guarding and tenderness in the epigastric region but is otherwise normal. In an effort to confirm your hypothesis, you should schedule a(n): a. electrocardiogram, because you think he has referred cardiac pain. b. colonoscopy, because you think he has diverticulitis. c. flat and erect abdominal x-ray study, because you think he has a perforated peptic ulcer. d. glucose tolerance test, because you think he has diabetes-related gastroparesis. ANS: C
Do not undertake procedures that are not reasonably related to your hypothesis. In this case, because of his personal history and presenting symptoms, the most likely problem that unifies the presentation is peptic ulcer disease. DIF: Cognitive Level: Evaluating (Synthesis) REF: p. 611 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 9. Positive outcomes depend on the: a. number of laboratory tests ordered. b. quality of decisions made. c. use of pharmacologic modalities. d. time saved by the use of ancillary personnel. ANS: B
Positive patient outcomes are dependent on your ability to arrive at accurate hypotheses that then direct quality patient care decisions. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 611 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 10. Self-analysis assists providers in giving proper context to: a. history and physical findings. b. therapeutic options. c. attitudes, values, and feelings. d. differential diagnoses. ANS: C
Knowing the intensity of your personal attitudes, values, and emotional feelings about patient care situations helps prevent you from being overtaken by your own impaired or distorted viewpoints. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 610 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 11. Medical decision making requires a balance between: a. trust and suspicion. b. ethical and unethical behavior. c. remembering and superstition.
d. mechanism and probability. ANS: D
In making medical decisions, you cannot be too scientific or pursue every possible scenario. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 12. A valid history and physical examination can serve to: a. create higher health care costs. b. limit the indiscriminate use of diagnostics. c. threaten patient satisfaction. d. increase the risk of liability. ANS: B
A comprehensive history with a competent clinical examination can lead you to generate a more accurate problem list, and therefore increase the proper usage of diagnostic testing while limiting its indiscriminate use. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 13. The use of computers in health care is: a. an appropriate substitute for critical thinking. b. nonthreatening. c. helpful for recording and providing information. d. a substitute for patient-provider interaction. ANS: C
The computer is a useful tool in the clinical setting for documenting patient care and retrieving information. It cannot substitute for the clinician’s critical thinking or for patient interaction. For some clinicians, computer use is a threatening skill and poses confidentiality issues. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 612 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 14. Which of the following statements represents a valid threat posed by computers in patient care
areas? a. Computers pose a serious threat to confidentiality. b. Computers increase the cost of the care of each visit. c. Computer software cannot increase productivity. d. Computers emit hazardous electromagnetic radiation. ANS: A
The use of computers in clinical areas, with their ease of accessibility of data, poses a serious threat to patient confidentiality. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 612 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 15. Which of the following is true regarding the clinical use of computers?
a. b. c. d.
It can be a useful substitute for critical thinking. It can remind us about unrecognized possibilities in diagnosis. It helps protect against breached confidentiality. It allows for the detection of human subtleties.
ANS: B
Computers can alert us to alarming values in laboratory results or provide us with interpretative guidelines so that unrecognized possibilities in diagnosing become evident. However, computers cannot substitute for critical thinking, nor can they sense human subtleties, and their use in clinical settings threatens confidentiality. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 612 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 16. When evaluating results of laboratory tests, a test that is highly sensitive implies that the test: a. suggests that a disease is present when it actually is not. b. is able to confirm a diagnosis, even when disease is not present. c. suggests that a disease is absent when it is absent. d. is able to identify the disease being tested correctly. ANS: D
A test that is sensitive is a test that will be able to identify correctly persons with the disease for which the test has been designed. Positive results are more likely to be positive for the disease. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 17. A specific test is one that has the ability to: a. correctly identify those who have the disease. b. correctly identify those who do not have the disease. c. be exclusively used to make a diagnosis. d. exclude competing explanations for another test finding. ANS: B
The specificity of a test is determined by its ability to identify those who do not have the disease for which the test has been designed. Negative results are more likely to be valid. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 18. Mr. Johnson actually has streptococcal pharyngitis; however, the throat culture is initially read
as negative. This situation describes a test with a: a. low sensitivity. b. high sensitivity. c. high specificity. d. low specificity. ANS: A
This situation describes a test designed to test those who are positive for the disease. At this time, the test was not able to detect a true-positive; therefore, the test had a low sensitivity.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 614 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 19. The likelihood of your diagnosis being related to your findings is dependent on: a. the number and magnitude of the presenting problems. b. the prevalence of both in the particular population. c. your ability to validate your first impression. d. your experience with the particular condition. ANS: B
The Bayes formula points out that the likelihood of a diagnosis you make being related to your clinical findings depends on the prevalence of each of these in the population you serve. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 20. To limit uncertainty in diagnostic decision making, the ratio of fact to conjecture must be: a. positive. b. negative. c. negligible. d. inverse. ANS: A
If in doubt about a clinical decision, then recheck the validity of your decision. Uncertainty is limited when the facts outweigh conjecture, or when the ratio between the two is a positive value. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 614 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 21. Which of the following is not a component of a management plan? a. Presumptive diagnosis b. Referral for a surgical procedure c. Diet modification d. Physical therapy ANS: A
The management plan details what you are going to do about a patient problem such as surgical consults, diet modifications, and physical therapy referrals. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 614 OBJ: Nursing process—implementing MSC: Safe and Effective Care: Management of Care 22. When determining actions for the management plan, the practitioner should first address: a. problems in the order of their chronologic development. b. the patient’s concern about a particular problem. c. the patient’s social and economic circumstances. d. the most urgent problem. ANS: D
In developing patient care plans, priority should be given to the most life-threatening and urgent physical needs of the patient. Then focus on addressing the patient’s social and economic circumstances. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 614 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care COMPLETION 1. The proportion of persons with an observation characteristic of a disease who have the disease
is known as the ____________ value. ANS:
positive predictive The positive predictive value is defined as the proportion of persons thought to have a disease who actually test positive for the disease. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care 2. The ability of an observation to identify correctly those who have the disease is called
____________. ANS:
sensitivity Sensitivity allows for the ability of an observation to correctly identify those who have the disease. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 613 OBJ: Nursing process—diagnosis MSC: Safe and Effective Care: Management of Care MULTIPLE RESPONSE 1. In setting priorities for the evaluation and management plan, which of the following should be
included? (Select all that apply.) a. Consultations b. Laboratory studies c. Patient transportation d. Occam’s razor e. Medications ANS: A, B, C
The evaluation and management plan is made after diagnosis, and several factors are involved in setting priorities. Occam’s razor applies to the diagnosis process and is not part of the evaluation and management plan. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 614 OBJ: Nursing process—evaluating MSC: Safe and Effective Care: Management of Care
Chapter 26: Recording Information Test Bank—Nursing MULTIPLE CHOICE 1. If information is purposely omitted from the record, you should: a. erase the notes that are not pertinent. b. accept that sometimes data are omitted. c. state in the record why the information was omitted. d. use correction fluid to cover the information. ANS: C
Any deferred or omitted portion of the patient record requires proper documentation that documents this occurrence, along with a rationale for doing so. Erasures and use of correction fluid are inappropriate methods. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 616
2. Which part of the information contained in the patient’s record may be used in court? a. Subjective information only b. Objective information only c. Diagnostic information only d. All information ANS: D
Anything that is entered into a patient’s record, in paper or electronic form, is a legal document and can be used in court. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 616
3. During the course of the interview, you should: a. take no notes of any kind. b. take brief written notes. c. take detailed written notes. d. repeat pertinent comments into a dictation devise. ANS: B
During the interviewing process, it is important to maintain eye contact with the patient and to spend as little time as possible looking at your notes, so brief written notes are more practical. Later you can go back and formulate a well-versed history by linking all the pieces together. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 616
4. Ms. S reports that she is concerned about her loss of appetite. During the history, you learn
that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S’s loss of appetite, it would be better to: a. defer or omit her comments. b. have her husband call you. c. quote her concerns verbatim. d. refer her for psychiatric treatment. ANS: C
It is best to document what you observe and what is said by the patient rather than documenting your interpretation. Listening and quoting exactly what the patient says is the better rule to follow. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 621
5. Subjective and symptomatic data are: a. documented with the physical examination findings. b. not mentioned in the legal chart. c. placed in the history section. d. recorded with the examination technique. ANS: C
Subjective data, as well as symptomatic data, should be placed in the history section. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 621
6. The quality of a symptom, such as pain, is subjective information that should be: a. deferred until the cause is determined. b. described in the history. c. placed in the past medical history section. d. placed in the history with objective data. ANS: B
Information about pain is subjective and only the patient can rate the perceived severity. Pain, therefore, should be recorded in the history. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 616
7. Which of the following is an effective adjunct to document the location of findings during the
recording of the physical examination? a. Relationship to anatomic landmarks b. Computer graphics c. Comparison with other patients of same gender and size d. Comparison to previous examinations using light pen markings ANS: A
Abnormal or normal findings are best described in relationship to universal topographic and anatomic landmarks. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 618
8. The position on a clock, topographic notations, and anatomic landmarks: a. are methods for recording locations of findings. b. are used for noting disease progression. c. are ways for recording laboratory study results. d. should not be used in the legal record. ANS: A
Descriptions of the locations of findings are universally referenced by using positions on a clock, topographic notations, or anatomic landmarks. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 618
9. Regardless of the origin, discharge is described by noting: a. a grading scale of 0 to 4. b. color and consistency. c. demographic data and risk factors. d. associated symptoms in alphabetic order. ANS: B
Regardless of where the discharge originates, color and consistency determine whether it is an expected finding. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 619
10. Drawing of stick figures is most useful to: a. compare findings in extremities. b. demonstrate radiation of pain. c. indicate consistency of lymph nodes. d. indicate mobility of masses. ANS: A
Simple drawings, such as stick figures, are more practical illustrations for findings in extremities. Radiation of pain, consistency of lymph nodes, and mobility of masses would not be adequately described by such simple drawings. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 619
11. Which of the following is an example of a problem that requires recording on the patient’s
problem list?
a. b. c. d.
Common age variations Expected findings Problems needing further evaluation Minor variations
ANS: C
Any problem is worth noting on the patient problem list, even if the cause or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as a problem. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 619
12. A problem may be defined as anything that will require: a. evaluation. b. medication. c. surgery. d. treatment. ANS: A
The need for further evaluation or attention indicates a problem. If a problem is found, it does not necessarily warrant medication, surgery, or treatment. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: pp. 619-620
13. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. d. plan. ANS: C
Differential diagnoses for problems that have not been diagnosed are placed in the assessment category for each problem. The differentials are prioritized, and contributing factors are identified. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 620
14. When recording assessments during the construction of the problem-oriented medical record,
the examiner should: a. combine all data into one assessment. b. create an assessment for each problem on the problem list. c. create an assessment for every abnormal physical finding. d. create an assessment for every symptom presented in the history. ANS: B
Once the examiner has a list of problems constructed, an assessment is made for each unique problem. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 620
15. Which of the following is not a component of the plan portion of the problem-oriented
medical record? a. Diagnostics ordered b. Therapeutics c. Patient education d. Differential diagnosis ANS: D
The differential diagnosis is part of the assessment phase. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 620
16. Your patient returns for a blood pressure check 2 weeks after a visit during which you
performed a complete history and physical. This visit would be documented by creating a(n): a. progress note. b. accident report. c. problem-oriented medical record. d. triage note. ANS: A
A second visit with the clinician is always recorded on a progress note, noting any updates to the condition. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 621
17. A detailed description of the symptoms related to the chief complaint is presented in the: a. history of present illness. b. differential diagnosis. c. assessment. d. general patient information section. ANS: A
The signs and symptoms and historical data of the patient’s experience that led up to the chief complaint are placed in the history of present illness. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 621
18. The effect of the chief complaint on the patient’s lifestyle is recorded in which section of the
medical record?
a. b. c. d.
Chief complaint History of present illness Past medical history Social history
ANS: B
The effect of the patient’s complaint on current everyday lifestyle or work performance is recorded in the history of present illness. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 621
19. The patient’s perceived disabilities and functional limitations are recorded in the: a. problem list. b. general patient information. c. social history. d. past medical history. ANS: D
The past medical history contains information about the patient’s lifestyle as well as disabilities or functional limitations that alter activities of daily living. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 622
20. The review of systems is a component of the: a. physical examination. b. health history. c. assessment. d. past medical-surgical history. ANS: B
The review of systems relates health history according to physical systems and is presented just before the actual physical examination. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: pp. 621-622
21. Allergies to drugs and foods are generally listed in which section of the medical record? a. History of present illness b. Past medical history c. Social history d. Problem list ANS: B
The past medical history section contains information such as allergies to drugs and foods and environmental allergies. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation
REF: p. 622
MSC: Physiologic Integrity: Basic Care and Comfort 22. Ms. G is being seen for her routine physical examination. She is a college graduate and
president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of this information is part of Ms. G’s _____ history. a. family b. past medical c. personal and social d. present problem ANS: C
Information such as education and economic condition is part of the personal and social history. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 622
23. Information recorded about an infant differs from that recorded about an adult, mainly
because of the infant’s: a. attention span. b. developmental status. c. nutritional differences. d. source of information. ANS: B
The organizational structure of an infant’s record is different because the infant’s current and future health are referenced in terms of developmental status. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 626
24. In which section of the newborn history would you find details of gestational assessment and
extrauterine adjustment data? a. Family b. Past medical c. Personal and social d. Present problem ANS: D
For the newborn, the focus of recorded information is the details of the mother’s pregnancy, gestational development, and events occurring since birth. These data are recorded in the present problem section of the history. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 626
25. Which finding is unique to the documentation of a physical examination of an infant? a. Fontanel size b. Liver span
c. Prostate size d. Thyroid position ANS: A
The size and characteristic of the fontanel are unique and important in the assessment of an infant. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 626
26. Eye examination of the newborn does not routinely include assessment of: a. the red reflex. b. the corneal reflex. c. object tracking. d. the fundus. ANS: D
The fundus of the eye is not routinely assessed in a newborn. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 626
27. Data relevant to the social history of older adults includes information on: a. family support systems. b. previous health care visits. c. over the counter medication intake. d. date of last cancer screening. ANS: A
The social history of older adults includes community and family support systems. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 628
28. A SOAP note is used in which type of recording system? a. Preventive care b. Problemoriented c. Systems review d. Traditional treatment ANS: B
A SOAP note—subjective problem data, objective problem data, assessment, and plan— is a type of recording system that has a problem-oriented style. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 620
29. The examiner’s evaluation of a patient’s mental status belongs in the: a. history of present illness.
b. review of systems. c. physical examination. d. patient education. ANS: C
Mental status assessment, including cognitive and emotional stability and speech and language, is part of the physical examination. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 624
30. When recording physical findings, which data are recorded first for all systems? a. Inspection b. Percussion c. Palpation d. Auscultation ANS: A
Physical assessment for all systems begins with inspection. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 618
31. Which of the following formats would be used for visits that address problems not yet
identified in the problem-oriented medical record (POMR)? a. Brief SOAP note b. Comprehensive health history c. Progress note d. Referral note ANS: A
Follow-up visits for problems identified in the POMR are recorded in the progress notes. Those visits not identified as problems are recorded using the SOAP format. Careful review of all SOAP notes on a regular basis will detect the emergence of a condition that explains the patient’s complaints; at that point, SOAP documentation is stopped. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 618
32. George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his
allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care? a. GM is a 22-year-old male here for “allergies.” b. GM came into the clinic complaining of green discharge for the past 72 hours. c. GM, a 22-year-old male, states that he has allergies and wants them checked. d. GM is a 22-year-old male here for having “green nasal discharge” for the past 72 hours. ANS: D
Documentation of the chief complaint should always be done by using the patient’s own words in quotation marks. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 616
COMPLETION 1. When using the mnemonic OLDCARTS, the A stands for ______________________. ANS:
aggravating and associated factors The OLDCARTS mnemonic helps make sure that all characteristics of a problem are described in the history of present illness to ensure a comprehensive presentation. The order of recording these characteristics does not need to be consistent. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process—communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort
REF: p. 622
Chapter 27: Emergency or Life-Threatening Situations Test Bank—Nursing MULTIPLE CHOICE 1. During initial ABCDE assessments of life-threatening conditions, D (disability) in neurologic
status is assessed by the patient’s: a. pupil size. b. degree of responsiveness. c. nuchal rigidity. d. mood and affect. ANS: B
The D (disability) in neurologic status of the primary assessment is assessed by determination of the patient’s degree of responsiveness to stimuli. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 634 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 2. You have gone by ambulance to a construction site where an adult male is lying on the street.
The only information you have is that he fell three stories. His neck is immobilized with sacks of concrete mix on either side. Your first action should be to determine: a. airway patency. b. bleeding sites. c. cranial nerve function. d. limb position. ANS: A
On arriving at the site, the patency of the upper airway is the priority and should be managed before proceeding with further assessments. DIF: Cognitive Level: Applying (Application) REF: p. 633 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 3. The ABCs of a primary survey would be interrupted to: a. complete the assessment record. b. manage life-threatening conditions. c. reassess the patient’s temperature. d. transport the patient via airlift. ANS: B
The primary assessment is interrupted to manage a life-threatening condition as soon as it is detected. Once the condition is stabilized, the primary assessment is continued. Recording of events as they occur should be completed in a manner that does not interrupt continued care or transport. Reassessment of the patient’s temperature is inappropriate because it would interrupt the continued assessment process. Transporting the patient may begin after the primary assessment has been completed to determine the needs of the patient adequately. DIF: Cognitive Level: Applying (Application) REF: p. 635 OBJ: Nursing process—implementing MSC: Safe and Effective Care: Management of Care
4. The term status epilepticus is defined as: a. convulsive activity uncontrolled by medication. b. nonconvulsive brain wave disturbance, with psychomotor dysfunction. c. protracted convulsions with unresponsiveness lasting up to 1 hour. d. seizures that result in hypotension, pallor, and prolonged diaphoresis. ANS: C
Status epilepticus is characterized by seizures that are protracted and recurrent without recovery of consciousness and that can be prolonged for as long as 60 minutes. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 644 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 5. Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats/min, and
increasing dyspnea are signs of: a. intracranial pressure. b. pulmonary hypertension. c. status asthmaticus. d. tetanic contractions. ANS: C
Status asthmaticus is a severe and prolonged asthma attack that resists the usual therapeutic approaches. The patient experiences dyspnea, can only get out a few words between breaths, and has tachycardia often greater than 130 beats/min and pulsus paradoxus greater than 20 mm Hg. Pulsus paradoxus is more likely in pericardial effusion, constrictive pericarditis, and severe asthma. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 644 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 6. The Cushing triad includes: a. tachycardia. b. irregular respirations. c. tachypnea. d. constricted pupils. ANS: B
The Cushing triad is associated with increased intracranial pressure. It includes bradycardia, hypertension, and irregular respirations, even Cheyne-Stokes respirations. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 643 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 7. Blood, vomitus, and foreign bodies are removed from the oropharynx of the unconscious
patient by: a. stimulating the cough reflex. b. using a sweeping motion with the finger. c. performing a back thrust. d. using suction. ANS: D
Suction is used to remove blood, vomitus, or foreign bodies from the airway of an unconscious patient. The other choices put the patient at risk for aspiration or further injury if a neck injury is involved. DIF: Cognitive Level: Applying (Application) REF: p. 632 OBJ: Nursing process—implementing MSC: Safe and Effective Care: Management of Care 8. While performing the primary survey on a trauma victim, the patient is answering your
questions. You may assume that during the time of the questioning: a. his airway is open. b. he is alert and oriented. c. no head injury has occurred. d. there is no respiratory compromise. ANS: A
The patency of the upper airway is assessed at the start by asking the patient a question. If the patient answers, this is a sign that the airway is open at this time. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 632 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 9. If trauma above the clavicle is suspected, it is important to: a. test range of motion of the neck. b. remove any headgear. c. arrange for neck extension x-ray studies. d. stabilize the neck in a neutral position. ANS: D
If trauma above the clavicle is suspected, it is necessary to control the cervical spine by stabilizing the neck in a neutral position. Excessive movement can convert a fracture or dislocation without neurologic damage to one with neurologic damage. DIF: Cognitive Level: Applying (Application) REF: p. 632 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 10. Paradoxical chest movement suggests a: a. spontaneous pneumothorax. b. flail chest. c. clavicle fracture. d. pulmonary contusion. ANS: B
Paradoxical chest movement is associated with fractured ribs or a flail chest. This fracture should be stabilized immediately. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 633 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 11. Respiratory distress may be evidenced by: a. retractions of accessory muscles. b. bradycardia. c. flushed skin.
d. decreased capillary refill time. ANS: A
Respiratory distress results in an increased intrathoracic negative pressure as the body attempts to suck in more atmospheric air. This increased negative pressure causes the chest wall skin to retract around the ribs during inspiration. The other choices are related to cardiovascular distress. DIF: Cognitive Level: Applying (Application) REF: p. 633 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 12. On palpating the chest wall of a trauma patient, you feel subcutaneous crepitus (emphysema),
which is a sign that: a. air has leaked into soft tissue. b. a fracture underlies the injury. c. a foreign body is present. d. there is vascular obstruction. ANS: A
Crepitus is a sign of air leakage into soft tissue. Crepitus in soft tissues is caused by air that has penetrated the area as a result of injury; it is also referred to as subcutaneous emphysema. Bony crepitus is a grating or grinding sensation caused by fractured bone ends or joints rubbing together. A foreign body could obstruct the patient’s airway, producing stridor, or a bark may be heard with an obstructed airway. DIF: Cognitive Level: Applying (Application) REF: p. 632 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 13. Clear or amber drainage from the nose or ears of a blunt trauma patient may indicate: a. epiglottitis. b. a retropharyngeal abscess. c. a basilar skull fracture. d. a perforated tympanic membrane. ANS: C
Clear or amber drainage from the nose or ears may indicate a basilar skull fracture. Bloody drainage is associated with a perforated tympanic membrane. DIF: Cognitive Level: Applying (Application) REF: p. 635 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 14. Delayed capillary refill may alert you to: a. hypovolemic shock. b. moderate hypoxemia. c. subnormal intracranial pressure. d. upper respiratory infection. ANS: A
Delayed capillary refill means that the vessels are taking an extended time to fill, which is a sign of decreased cardiac output. To assess peripheral perfusion further and detect hypovolemic shock, note the skin color, presence and quality of pulses, and temperature of the extremities.
DIF: Cognitive Level: Applying (Application) REF: p. 643 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 15. Capillary refill can be assessed by applying pressure over a nail bed or a(n): a. bony prominence. b. eyelid. c. mucous membrane. d. femoral vein. ANS: A
Capillary refill can be assessed by pressing firmly over a nail bed or bony prominence such as the chin, forehead, or sternum until the skin blanches. Count the seconds it takes for color to return. Less than 2 seconds is a normal finding, and longer than 2 seconds indicates poor perfusion. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 634 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 16. The secondary survey of a patient with hypotension would begin with the assessment of: a. blood type. b. level of consciousness. c. number of fractures. d. swallowing ability. ANS: B
Secondary assessments are done after life-threatening problems are determined. For the hypotensive patient, it would be most important to begin secondary assessment of cerebral perfusion by determining the patient’s level of consciousness. DIF: Cognitive Level: Applying (Application) REF: p. 635 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 17. You would complete a Glasgow Coma Scale rating during the: a. health history. b. physical examination. c. primary survey. d. secondary survey. ANS: D
During the secondary survey, the full range of injuries are determined. The level of consciousness is determined, and the Glasgow Coma Scale is scored as indicated. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 636 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 18. Mr. Stinson is a 34-year-old patient who presents to the emergency department after an auto
accident. On examination, you note raccoon eyes and a positive Battle sign. Raccoon eyes and the Battle sign are associated with: a. multisystem trauma. b. orbital fractures. c. basilar skull fractures.
d. subdural hematoma. ANS: C
Raccoon eyes (bruising around the eyes) and the Battle sign (bruising behind the ears) both indicate a basilar skull fracture. Symptoms of orbital fractures are swelling of the eyelid, bruising of the eye, pain in the eye, double vision, and decreased movement of the affected eye. Signs and symptoms of a subdural hematoma are loss of consciousness after the original injury, steady or fluctuating headache, weakness, numbness or inability to speak, slurred speech, nausea, vomiting, lethargy, and seizures. DIF: Cognitive Level: Applying (Application) REF: p. 636 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 19. A life-threatening condition is recognized with the assessment of: a. pain with downward pressure on both anterior superior iliac spines. b. guarding and intense pain with deep palpation of the abdomen. c. distant and muffled heart sounds, with distended neck veins. d. severe throbbing pain in one eye, with photophobia. ANS: C
Distant, muffled heart sounds and distended neck veins may indicate cardiac tamponade, a life-threatening condition. Iliac spine pain indicates a pelvic fracture that may become lifethreatening depending on the extent of occult bleeding. Intense pain with deep palpation is not certain to be deadly. Eye pain with photophobia signals acute glaucoma, which can lead to blindness if treatment is delayed. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 636 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 20. The application of blunt sternal pressure is used to detect: a. a fracture of attached ribs. b. the motor function of the T7 dermatome. c. pneumothorax. d. cardiac contusion. ANS: A
Blunt sternal pressure will be painful if any attached ribs are fractured. Sternal pressure is applied to the chest to assess the stability of the chest wall. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 635 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 21. Until they are stabilized, trauma patients require reevaluation: a. every 2 minutes. b. every 5 minutes. c. every 10 minutes. d. every hour. ANS: B
An unstable patient must be reevaluated frequently so that any new signs and symptoms are not overlooked. A primary survey should be performed every 5 minutes and the results compared with those obtained in previous surveys.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 636 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 22. During injury assessment, one of the most crucial historical components is: a. number of siblings. b. history of prior fractures. c. mechanism of injury. d. past and current occupational exposure. ANS: C
In cases of trauma, the secondary assessment is intended to identify the full range of injuries, with particular focus on body systems affected by the mechanism of injury. All the other choices are not crucial for the emergency. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 635 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Basic Care and Comfort 23. Which condition manifests as unexplained shortness of breath (SOB) and cough with
hemoptysis? a. Bleeding ulcer b. Myocardial infarction c. Pulmonary embolism d. Transient ischemia ANS: C
Symptoms of pulmonary embolism include sudden onset of unexplained SOB, pleuritic chest pain, and coughing, with pink frothy sputum. Bleeding ulcer symptoms are coffee grounds emesis with gnawing pain in the upper abdomen. Myocardial infarction is signified by crushing pain in the center of the chest radiating to the arm, neck, or jaw, diaphoresis, nausea and vomiting, SOB, and a feeling of impending doom. Transient ischemia occurs with a sudden feeling of weakness and loss of movement of the arms or legs, numbness and/or tingling in any part of the body, excruciating headache, and/or difficulty speaking. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 644 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 24. Which injury is the most common precipitator of blunt trauma? a. Age-related falls b. Motor vehicle accidents c. Work-related injuries d. Childhood play injuries ANS: B
Motor vehicle accidents account for the majority of severe blunt trauma cases. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 637 OBJ: Nursing process—planning MSC: Physiologic Integrity: Basic Care and Comfort 25. When calculating the force of impact of a penetrating object, use: a. the size of the missile and size of the patient. b. the time of the incident and depth of the wound.
c. the amount of blood loss and level of consciousness. d. the velocity of the missile and distance from the source. ANS: D
When calculating the force of impact of a penetrating object, the amount of force is measured by the velocity of the missile and distance from the source. The force of the penetrating object on impact determines the transfer of energy. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 637 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 26. Adults and children display different physiologic responses to injury and acute illness. An
important concept to remember when assessing infants and children is that they: a. experience lethal arrhythmias first, progressing to respiratory failure. b. usually experience cardiac arrest before respiratory failure. c. usually experience respiratory arrest before circulatory failure. d. tolerate greater volume changes, with less severe consequences. ANS: C
Cardiac arrest is rarely a primary event in children, as it is in adults. The child usually experiences respiratory and ventilatory failure that progresses to respiratory arrest first. Without rapid intervention, a cardiac arrest occurs as a secondary event. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 638 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 27. The approximate expected systolic blood pressure for a child older than 1 year is: a. 120 + child’s age in years. b. 80 + child’s age in years. c. 120 – child’s age in years. d. 80 + (2 the child’s age in years). ANS: D
Use the equation 80 + (2 the child’s age in years) to calculate the expected systolic blood pressure for a child older than 1 year. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 638 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort 28. In life-threatening emergencies, consent for treatment: a. is obtained before treatment to protect the facility from liability. b. is not necessary. c. occurs after treatment is administered. d. is not valid because the patient is not competent. ANS: C
In life-threatening emergencies, the needed treatment should usually be given and formal consent obtained later. DIF: Cognitive Level: Applying (Application) REF: p. 641 OBJ: Nursing process—implementing MSC: Physiologic Integrity: Basic Care and Comfort
29. A patient whose spleen is ruptured will show a positive ________ sign. a. Battle b. Gower c. Grey Turner d. Kehr ANS: D
A Kehr sign is severe pain in the subscapular area of the shoulder, usually the left shoulder, and is evidence of a ruptured spleen. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 636 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort COMPLETION 1. In the primary survey of your trauma patient, you discover a bluish discoloration in the
periumbilical area. You will chart this as a _________ sign. ANS:
positive Cullen A Cullen sign is a bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 636 OBJ: Nursing process—diagnosis MSC: Physiologic Integrity: Basic Care and Comfort
Chapter 01: The History and Interviewing Process Test Bank—Medical MULTIPLE CHOICE 1. Which question would be considered a “leading question?” a. “Please describe any associated symptoms with your headaches?” b. “You don’t get headaches often, do you?” c. “What activities affect the severity of your headaches?” d. “What times of the day are your headaches the most severe?” e. “What worries you most about your headache.” ANS: B
This question would limit the information in the patient’s answer. The other choices allow the patient more discretion about the extent of an answer. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
2. To prevent personal appearance from becoming an obstacle in patient care, the health care
professional should a. wear a uniform. b. always wear a white coat. c. avoid extremes in dress. d. avoid wearing any jewelry. e. avoid wearing white. ANS: C
Sensible personal habits, along with avoidance of extremes in behavior and dress, contribute to establishing a trusting relationship between the provider of care and the patient. Uniforms help identify roles rather than relationships. REF: p. 3
TOP: Discipline: Behavioral Science
MSC: Organ System: General
3. Which action would best promote accurate translations as well as confidentiality when the
caregiver does not speak the patient’s language? a. Ask a person unfamiliar with the patient to translate. b. Have a friend of the patient translate. c. Ask simple leading questions that the patient may understand. d. Use a neighbor as translator. e. Involve the family with the translation. ANS: A
When you do not speak the patient’s language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased. REF: p. 3
TOP: Discipline: Behavioral Science
4. When are open-ended questions generally most useful? a. During the physical examination
MSC: Organ System: General
b. c. d. e.
After several close-ended questions have been asked While designing the genogram During the review of systems During the initial part of the interview
ANS: E
Asking open-ended questions at the beginning of an interview allows you to gather more information and establishes yourself as an empathic listener, which is the first step of effective communication. Interviewing for the purpose of conducting a genogram or review of systems requires more focused data that can be more easily gathered with direct questioning. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
5. Behaviors that diffuse anxiety during the interview include a. trying to limit the patient to simple “yes” or “no” answers. b. providing forthright answers to questions. c. providing all necessary information before the patient has to ask for it. d. completing the interview as quickly as possible. e. avoiding the wearing of uniforms and laboratory coats. ANS: B
To relieve anxiety, the health care professional should answer patient questions in a forthright manner, avoiding overload of information and without hurrying the conversation. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
6. Periods of silence during the interview can serve important purposes, such as a. allowing the clinician to catch up on documentation. b. giving you a clue that you should speed up the interview. c. providing time for reflection. d. increasing the length of the visit. e. promoting calm. ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
7. Which technique is most likely to result in the patient’s understanding of questions? a. Use phrases that are commonly used by other patients in the area. b. Use the patient’s own terms if possible. c. Use language that keeps the patient from being expansive in his or her answer. d. Use proper medical and technical terminology. e. Use the simplest language possible. ANS: B
To ensure that your questions have been correctly understood, be clear and explicit while using the patient’s idiom and level of understanding. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
8. Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F.
says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. F. states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? a. “After 3 days, you’re tired of coughing. Have you had a fever?” b. “I’d like to hear more about your experiences. Where were you born?” c. “You may have a serious problem, and being confrontational will not help.” d. “I’ll examine you and figure out the problem later.” e. “I don’t know what’s wrong. You could have almost any disease.” ANS: A
This is the only response aimed at focusing on the chief concern to gather more data and does not digress from the issue. REF: p. 6
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. A patient becomes restless during the history and says, “I don’t have time for all of this
conversation. I’ve got to get back to work.” Your most appropriate response would be to a. stop using open-ended questions and become more direct. b. ask another open-ended question and insist on an answer. c. ask questions about his anger and move closer to him. d. acknowledge his anger and proceed with the history and examination. e. ignore his displeasure and become more assertive about getting answers. ANS: D
This is the only that resists the tendency for patient manipulation, pursues the information, and confronts the patient’s anger. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. When questioning a patient regarding alcohol intake, she tells you that she is “only a social
drinker.” Which initial response is appropriate? a. “I’m glad that you are a responsible drinker.” b. “Many people who are really alcoholic say they are social drinkers.” c. “What amount and what kind of alcohol do you drink in a week?” d. “If you only drink socially, you won’t need to worry about always having a designated driver.” e. “Do the other people in your household consume alcohol?” ANS: C
This answer clarifies the patient’s own term without asking a leading question or being judgmental. REF: p. 7
TOP: Discipline: Behavioral Science
MSC: Organ System: General
11. Ms. T. is crying and states that her mother couldn’t possibly have a tumor. “No one else in the
family has ever had cancer!” exclaims the daughter. The most appropriate response to Ms. T. would be a. “Has anyone explained hospice care to your mother?”
b. c. d. e.
“I’m so sorry that your mother was diagnosed with cancer.” “Didn’t you know that all tumors are not cancerous?” “Why do you think that your mother’s tumor is cancerous?” “That is odd because cancer usually runs in families.”
ANS: D
This is the only answer that is a direct exploration of the daughter’s concern. The health care provider can explain and clarify the concerns of the daughter. REF: p. 7
TOP: Discipline: Behavioral Science
MSC: Organ System: General
12. A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has
had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate? a. “Can you describe the pain?” b. “The pain doesn’t radiate to your arm, does it?” c. “Have you been treated for anxiety before?” d. “Does your father have heart disease?” e. “Are the pains worse after you eat?” ANS: A
Initially, an open-ended question is a more appropriate response. ”Can you describe the pain?” is an open-ended question that offers clues to the chief concern. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
13. After you ask a patient about her family history, she says, “Tell me about your family now.”
Which response is generally most appropriate? a. Ignore the patient’s comment and continue with the interview. b. Give a brief, undetailed answer. c. Ask a direct question that refocuses the patient on the chief concern. d. Tell the patient that you do not discuss your family with patients. e. Ask the patient why she needs to know. ANS: B
This response will satisfy the patient’s curiosity about yourself without invading your private life. REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
14. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She
seems nervous as she speaks to you. An appropriate response is to a. continue to collect information regarding the chief concern in an unhurried manner. b. finish the interview as rapidly as possible. c. ask the patient to take a deep breath and calm down. d. ask the patient if she wants to wait until another day to talk to you. e. ignore her, because anxiety rarely accompanies physical disorders. ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor communicates caring to the patient.
REF: p. 4
TOP: Discipline: Behavioral Science
MSC: Organ System: General
15. Ms. A. states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one
of the following statements is the most appropriate caregiver response? a. “Try to think about the good things in life.” b. “You shouldn’t feel that way; look at all the good things in your life.” c. “You can’t mean what you’re saying.” d. “If you think about it, nothing is worth getting this upset about.” e. “What in life is causing you such pain?” ANS: E
Specific yet open-ended questions are best used when the patient has feelings of loss of selfworth and depression. The other responses hurry the patient and offer superficial assurance. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. During an interview, tears appear in the patient’s eyes, and his voice becomes shaky. Initially,
you should a. ask the patient what he is upset about. b. offer a tissue and let him know it is all right to cry. c. explain to the patient that you will be able to help him more if he can control his emotions. d. keep the interview moving to distract the patient. e. ask him if he would like some time alone. ANS: D
When patients cry, it is best to allow the moment to pass at the patient’s pace. If you suspect a need to cry but the patient is suppressing it, give permission. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
17. During an interview, you have the impression that a patient may be considering suicide.
Which action is essential? a. Immediately begin proceedings for an involuntary commitment. b. Ask whether the patient has considered self-harm. c. Ask whether the patient would like to visit a psychiatrist. d. Record the impression in the patient’s chart and refer the patient for hospitalization. e. Avoid directly confronting the patient regarding your impression. ANS: B
If you think the patient may be considering suicide, he or she probably is. Mentioning it gives permission to talk about it. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
18. During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps
looking out the window. What should the caregiver do? a. Ask direct questions and insist on a “yes” or “no” answer to each question. b. Continue to ask questions until Mr. B. responds appropriately. c. Let the patient know all relevant information should be revealed in one interview.
d. Stop the interview until the patient is ready to cooperate. e. Make a note to pursue sensitive issues later in the interview. ANS: D
When the patient dissembles, do not push too hard for an answer. Allow the interview to go on and come back to it later. Learning all that you may need to know about a patient may not happen in one interview. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
19. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they should a. never be interviewed alone because this may alienate the parent. b. be mailed a questionnaire in advance to avoid the need for her to talk. c. be given the opportunity to be interviewed without the parent at some point d. be allowed to direct the flow of the interview. e. be ignored while you address all questions to the parent. ANS: C
An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice. REF: p. 16
TOP: Discipline: Behavioral Science
MSC: Organ System: General
20. Information that is needed during the initial interview of a pregnant woman includes all of the
following except a. the gender that the woman hopes the baby will be. b. her past medical history. c. her health care practices. d. the woman’s knowledge about pregnancy. e. potential pregnancy risk factors. ANS: A
The initial interview for the pregnant woman should include information of about her past history, assessment of health practices, identification of potential risk factors, and assessment of her knowledge because it affects the pregnancy. REF: p. 17
TOP: Discipline: Behavioral Science
MSC: Organ System: General
21. When communicating with older children and teenagers, you should be sensitive to their a. parent’s needs. b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk. e. desire for adult companionship. ANS: D
Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality. REF: p. 16
TOP: Discipline: Behavioral Science
MSC: Organ System: General
22. When interviewing older adults, the examiner should a. speak extremely loudly because most older adults have significant hearing b. c. d. e.
impairment. provide a written questionnaire in place of an interview. position himself- or herself face to face with the patient. ask questions containing double negatives. dim the lights to decrease anxiety.
ANS: C
The health care provider should position himself- or herself so that the older patient can see his or her face. Shouting distorts vocalizations, dimming the lights impairs vision; a written interview may be necessary if all else fails. The provider’s language should be uncomplicated and free from double negatives. REF: p. 18
TOP: Discipline: Behavioral Science
MSC: Organ System: General
23. When you suspect that your 81-year-old patient has short-term memory loss because he
cannot remember what he had for breakfast, you should a. order a neurology consult. b. stop all of his medications. c. continue to press the patient for appropriate answers. d. validate the concern with his family or caregivers. e. dismiss the finding as a normal age-related change. ANS: D
When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps. REF: p. 19
TOP: Discipline: Behavioral Science
MSC: Organ System: General
24. To what extent should the patient with a physical disability or emotional disorder be involved
in providing health history information to the health professional? a. All information should be obtained from family members. b. All information should be collected from past records while the patient is in another room. c. The patient should be involved only when you sense that he or she may feel ignored. d. The patient should be fully involved to the limit of his or her ability. e. The patient should be present during information collection but should not be addressed directly. ANS: D
Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient. REF: p. 20
TOP: Discipline: Behavioral Science
MSC: Organ System: General
25. A brief statement of the reason the patient is seeking health care is called the a. medical history. b. chief concern
c. assessment. d. diagnosis. e. review of systems. ANS: B
The chief concern is a brief statement of the reason the patient is seeking health care. REF: p. 6
TOP: Discipline: Behavioral Science
MSC: Organ System: General
26. When taking a history, you should a. ask patients to give you any information they can recall about their health. b. start the interview with the patient’s family history. c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. e. start the interview with the social history. ANS: C
To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient’s family history and with the social history are incorrect because gathering data about the chief concern is the initial step. REF: p. 6
TOP: Discipline: Behavioral Science
MSC: Organ System: General
27. When questioning the patient regarding his or her sexual history, which question should be
asked initially? a. “Do you have any particular sexual likes or dislikes?” b. “Do you have any worries or concerns regarding your sex life?” c. “How often do you have intercourse and with whom?” d. “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” e. “What sexually transmitted diseases have you had in the past?” ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient’s feelings about the issue. REF: p. 10
TOP: Discipline: Behavioral Science
MSC: Organ System: General
28. A guideline for history taking is for caregivers to a. ask direct questions before open-ended questions so that the data move from b. c. d. e.
simple to complex. use a previous diagnosis as a chief concern whenever possible. make notes sparingly so that patients can be observed during the history taking. write detailed information as stated by patients so their priorities are reflected. ask for a complete history at once so that data are not forgotten between meetings.
ANS: C
During an interview, you should maintain eye contact with the patients, observing body language and proceeding from open-ended to direct questions.
REF: p. 3
TOP: Discipline: Behavioral Science
MSC: Organ System: General
29. Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit
drugs. This information would most likely belong in the a. chief concern. b. family history. c. personal and social history. d. review of systems. e. past medical history. ANS: C
Habits are included within the personal and social history. REF: p. 12
TOP: Discipline: Behavioral Science
MSC: Organ System: General
30. Direct questioning about intimate partner violence in the home should be a. a routine component of history taking with female patients. b. avoided for fear of offending the woman’s partner. c. conducted only in cases in which there is a history of abuse. d. used only when the patient is obviously being victimized. e. used only when bruises are found on physical examination. ANS: A
The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients. REF: p. 8
TOP: Discipline: Behavioral Science
MSC: Organ System: General
31. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for
problem drinking, you would use the a. Miller Analogies Test. b. PACE Assessment Instrument. c. CAGE questionnaire. d. Glasgow Coma Scale. e. HITS questionnaire. ANS: C
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol. REF: p. 8
TOP: Discipline: Behavioral Science
MSC: Organ System: General
32. A tool used to screen adolescents for alcoholism is the a. CAGE questionnaire. b. CRAFFT. c. PACE Assessment Instrument. d. HITS questionnaire. e. Glasgow Coma Scale. ANS: B
The CRAFFT tool is used to screen for alcoholism in adolescents. REF: p. 8
TOP: Discipline: Behavioral Science
MSC: Organ System: General
33. When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s
lap. She turns away from you when you greet her. Initially, your best response is to a. screen the child for sexual abuse. b. ask the child to be seated on the examination table so you can talk to her father. c. explain to the child that you will not hurt her and that she will have to trust you. d. ask the father to persuade the child to cooperate with you. e. leave the child sitting in the father’s lap while you talk to the father. ANS: E
Interaction with children must be modified according to age and in a manner that promotes trust. REF: p. 14
TOP: Discipline: Behavioral Science
MSC: Organ System: General
34. Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt
bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health? a. Attachment to parents b. Tendency to give too much information c. Low peer support needs d. Propensity for risk taking e. High self-esteem ANS: D
Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information. REF: p. 16
TOP: Discipline: Behavioral Science
MSC: Organ System: General
35. Pain is difficult to assess in older adults because a. their histories are usually unreliable. b. sharp pain may be felt as a dull ache. c. they tend to exaggerate symptoms. d. their language skills decline. e. drugs act more rapidly with age. ANS: B
Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner from those in other age groups. REF: p. 19
TOP: Discipline: Behavioral Science
MSC: Organ System: General
36. A survey of mobility and activities of daily living (ADLs) is part of a(n) a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. e. sexual history. ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living. REF: p. 19
TOP: Discipline: Behavioral Science
MSC: Organ System: General
37. Constitutional symptoms in the ROS refer to: a. height, visual acuity, and body mass index. b. fever, chills, fatigue, and malaise. c. hearing loss, tinnitus, and diplopia. d. rashes, skin turgor, and temperature. e. joint stiffness, redness, and swelling. ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change). REF: p. 13
TOP: Discipline: Behavioral Science
MSC: Organ System: General
38. J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of
acute sinusitis. The type of history that is warranted is a(n) _____ history. a. complete b. inventory c. problem or focused d. interim e. family ANS: C
If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate. REF: p. 20
TOP: Discipline: Behavioral Science
MSC: Organ System: General
39. Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more
and doesn’t hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle a. “Do you want to see a counselor today?” b. “Is your father out of jail yet?” c. “Are you taking any illegal drugs?” d. “Have you made plans to harm yourself?” e. “What sexual practices did you have with your girlfriend?” ANS: D
If you sense that a patient is contemplating suicide, you should ask about suicidal ideation directly. REF: p. 5
TOP: Discipline: Behavioral Science
MSC: Organ System: General
40. Which of the following is considered an IADL but not an ADL? a. Paying bills b. Toileting c. Walking around the house d. Dressing oneself
e. Eating ANS: A
Paying bills is an instrumental activity of daily living but not an activity of daily living. REF: p. 19
TOP: Discipline: Behavioral Science
MSC: Organ System: General
41. A pedigree diagram is drafted for the purpose of obtaining a. sexual orientation and history. b. growth and developmental status. c. genetic and familial health problems. d. ethnic and cultural backgrounds. e. the past medical history. ANS: C
Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems. REF: p. 12
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 02: Cultural Competency Test Bank—Medical MULTIPLE CHOICE 1. Which of the following describes a physical, not a cultural, differentiator? a. Ritual b. Rite c. Race d. Norm e. Ethos ANS: C
Race is a physical, not a cultural, differentiator. REF: p. 21
TOP: Discipline: Behavioral Science
MSC: Organ System: General
2. Which statement is true regarding the relationship of physical characteristics and culture? a. Physical characteristics should be used to identify members of cultural groups. b. There is a difference between distinguishing cultural characteristics and
distinguishing physical characteristics. c. To be a member of a specific culture, an individual must have certain identifiable
physical characteristics. d. Gender and race are the two essential physical characteristics used to identify
cultural groups. e. Whereas all cultural traits can be viewed as static, physical traits are dynamic. ANS: B
Physical characteristics do not symbolize cultural groups; there is a difference between the two, and they are considered separately. Cultures are dynamic in their evolution. REF: p. 21
TOP: Discipline: Behavioral Science
MSC: Organ System: General
3. A fixed image of any group that rejects its potential for originality or individuality is known as
a(n) a. acculturation. b. norm. c. stereotype. d. ethnos. e. custom. ANS: C
This definition describes a stereotype. A norm, on the other hand, is a standard of allowable behavior within a group, ethnos implies the same race or nationality, and acculturation is a process of adopting another culture’s behaviors. A custom refers to a habitual activity of a group in a given situation. REF: p. 21
TOP: Discipline: Behavioral Science
MSC: Organ System: General
4. Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L’s son
tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? a. “With your father’s permission, we will examine the stone and request that it be returned to him.” b. “The stone must be sent to the lab for examination and therefore cannot be kept.” c. “We cannot let him keep his stone because it violates our infection control policy.” d. “We don’t know yet if your father has another kidney stone, so we must analyze this one.” e. “I have found it unwise to make these kinds of individual exceptions to hospital procedure.” ANS: A
Health care providers should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient’s cultural background. It is better to mediate than to be coercive. The statement, “With your father’s permission, we will examine the stone and request that it be returned to him” does this most effectively. REF: p. 22
TOP: Discipline: Behavioral Science
MSC: Organ System: General
5. To develop cultural competence, one should a. ignore one’s own cultural beliefs. b. attempt to convince the patient to accept institutional mores. c. realize that cultural values are difficult to change and must be respected. d. realize that all members of a cultural group behave the same way. e. understand that an individual's culture has no effect on the delivery of health care
in this country. ANS: C
To develop cultural competence, health care providers should examine their own beliefs, respect the unfamiliar, appreciate that cultural values are difficult to change, and do not expect all members of a cultural group to behave exactly the same. Differences in culture can sometimes have an overpowering effect on the delivery of health and medical care. REF: p. 22
TOP: Discipline: Behavioral Science
MSC: Organ System: General
6. Your new patient is a 40-year-old Middle Eastern man with a complaint of new abdominal
pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to a. do the examination because it is a necessary part of the physical examination. b. ask a colleague from the same geographic area if this examination is acceptable. c. inform the patient of the reason for the examination and ask if it is acceptable to him. d. refer the patient to a provider more knowledgeable about cultural differences. e. forego the examination for fear of violating cultural norms. ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. REF: p. 22
TOP: Discipline: Behavioral Science
MSC: Organ System: General
7. Which statement is true regarding impoverished people? a. In the United States, socioeconomic status does not influence the delivery of health
care. b. The morbidity and mortality rates of impoverished people are greater than those of
the middle class. c. The morbidity and mortality rates of impoverished people are less than those of the
middle class. d. No reliable statistics exist regarding the relationship of poverty to morbidity and
mortality. e. The morbidity and mortality rates of impoverished people are similar to those of
the middle class. ANS: B
Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity. REF: p. 23
TOP: Discipline: Behavioral Science
MSC: Organ System: General
8. In terms of cultural communication differences, Americans are more likely to _____ than
other groups of patients. a. emphasize attitudes and feelings b. maintain eye contact c. come quickly to the point d. use silence comfortably e. speak more softly than other cultures ANS: C
In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard. REF: p. 26
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. Which question has the most potential for exploring a patient’s cultural beliefs related to a
health problem? a. “How often do you have a medical examinations?” b. “What are your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” e. “Do you take herbal remedies?” ANS: D
This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. REF: p. 24
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. A person’s definition of illness is likely to be most influenced by: a. race. b. ritual. c. enculturation. d. age group.
e. socioeconomic class. ANS: C
The definition of “ill” is determined in large part by the individual’s —the process whereby an individual assumes the traits and behaviors of a given culture. REF: p. 24
TOP: Discipline: Behavioral Science
MSC: Organ System: General
11. Informing a patient that he or she has a terminal illness is most likely to be discouraged in
which cultural group? a. Navajo Native Americans b. Dominant Americans c. First-generation African descendants d. First-generation European descendants e. Hispanics ANS: A
The Navajo culture believes that thought and language have the power to shape reality; the desire to avoid discussing negative information is particularly strong in this culture. REF: p. 26
TOP: Discipline: Behavioral Science
MSC: Organ System: General
12. A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids
eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask? a. “Why are you so depressed?” b. “It’s hard for me to gather useful information because your answers are so short.” c. “Are you uncomfortable talking with me?” d. “Does your religion make it hard for you to answer my questions?” e. “We will be able to communicate better if you will look at me.” ANS: C
It is all right to ask if the patient is uncomfortable with any aspect of your person and to talk about it; the other choices are less respectful. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
13. As you explain your patient’s condition to her husband, you notice that he is leaning toward
you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to a. tell him that you understand his need to be alone. b. ask whether he has any questions. c. ask whether he would prefer to speak to the clinician. d. tell him that it is all right to be angry. e. stop questioning the patient immediately. ANS: B
The English worry about being overheard and tend to speak in modulated voices, so when they lean in toward you, they are probably ready with a question. REF: p. 26
TOP: Discipline: Behavioral Science
MSC: Organ System: General
14. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native
Americans, Asians, and Arabs is Western medicine’s attempt to a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. use herbal remedies and rituals. e. promote balance in an individual’s life. ANS: B
A more scientific approach to health care problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more “holistic” approach. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
15. In a naturalistic or holistic approach to health, an example of a “hot” condition would be a. teething. b. joint pain. c. diarrhea. d. a nasal cold. e. a headache. ANS: C
A hot condition among cultures with a holistic approach is diarrhea. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. An example of a “cold” condition would be a. a fever. b. a rash. c. tuberculosis. d. an ulcer. e. a sore throat. ANS: C
A cold condition among cultures with a holistic approach is tuberculosis. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
17. An example of a cold food is a. chocolate. b. hard liquor. c. oil. d. onions. e. a dairy product. ANS: E
Dairy products are an example of a cold food; the others are hot. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
18. A naturalistic or holistic approach to health care often assumes a. that hot conditions require treatment with a hot remedy. b. a reductionist view that looks to a very narrow cause and effect. c. there are external factors that must be kept in balance. d. that there are hot and cold conditions but not hot and cold remedies. e. that hot and cold conditions are the same among different cultures. ANS: C
A naturalistic or holistic approach often assumes that there are external factors—some good, some bad—that must be kept in balance if we are to remain well. REF: p. 27
TOP: Discipline: Behavioral Science
MSC: Organ System: General
19. Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is
likely to be most problematic for the hypertensive patient of which group? a. Native Americans b. Hispanics c. Chinese d. Italians e. Orthodox Jews ANS: C
Of all the choices, the Chinese are more likely to use MSG and soy sauce in their diet. REF: p. 28
TOP: Discipline: Behavioral Science
MSC: Organ System: General
20. Which maternal factor is most predictive of whether an infant will receive inoculations? a. The mother has family support. b. The mother is divorced. c. The mother breastfeeds. d. The mother uses drugs. e. The mother received prenatal care. ANS: E
Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well. REF: p. 28
TOP: Discipline: Behavioral Science
MSC: Organ System: General
21. Adolescents most likely to smoke, abuse substances, perform poorly in school, and be
depressed are those who are a. from dual-income families. b. from families that emphasize strong religious beliefs. c. from deprived socioeconomic groups. d. unsupervised after school. e. involved in athletics after school. ANS: D
Adolescents who are unsupervised after school are more likely to smoke, abuse substances, perform poorly in school, and be depressed than adolescents in any other situation. REF: p. 28
TOP: Discipline: Behavioral Science
MSC: Organ System: General
22. Knowledge of the culture(s) of the patient should be used to a. form a standard practice procedure for that culture. b. draw conclusions regarding individual patient needs. c. form stereotypical categories. d. help make the interview questions more pertinent. e. form a sense of the patient based on prior knowledge. ANS: D
The purpose of understanding the patient’s culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. REF: p. 28
TOP: Discipline: Behavioral Science
MSC: Organ System: General
23. The attitudes of the health care professional are largely a. acculturated and cannot be changed. b. uninfluenced by patient behavior. c. difficult for the patient to sense. d. culturally derived. e. irrelevant to the success of relationships with the patient. ANS: D
The attitude of a health care provider is foundationally derived from his or her own culture but cannot cause stereotypical judgments to be made; understanding this is relevant to the success of patient relationships. Attitudes of the health care professional are easily detected by others, and they influence patient behavior. REF: p. 21
TOP: Discipline: Behavioral Science
MSC: Organ System: General
24. Being sensitive to cultural differences that may exist between you and the patient is most
useful in the avoidance of a. prejudice. b. stereotypic judgment. c. miscommunication. d. opinion formation. e. preaching to the patient. ANS: C
When you determine that cultural differences may exist, you must first use culturally sensitive communication modes to grasp what the patient means correctly or else prejudice, stereotypic judgment, tendency to preach, and you forming an opinion may inadvertently be perceived by the patient. REF: p. 26
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 03: Examination Techniques and Equipment Test Bank—Medical MULTIPLE CHOICE 1. Guidelines for Standard Precautions indicate that mask and eye protection or a face mask
should be worn while performing a. suture removal. b. trachea care and suctioning. c. wet-to-dry dressing changes. d. patient bathing. e. tube feedings. ANS: B
Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. REF: p. 31
TOP: Discipline: Pathophysiology
MSC: Organ System: General
2. Standard Precautions apply to all patients a. with bloodborne infections. b. with infected, draining wounds. c. in intensive care units. d. receiving care in hospitals. e. believed to have an infectious disease. ANS: D
Although all of these statements are true, the best answer is patients receiving care in hospitals. Standard Precautions were developed with the intent of application to the care of all hospitalized patients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered. REF: p. 30
TOP: Discipline: Pathophysiology
MSC: Organ System: General
3. According to the guidelines for Standard Precautions a. hand washing is not needed between tasks and procedures on the same patient. b. the caregiver’s hands should be washed only after touching blood products with
ungloved hands and after caring for infectious patients. c. the caregiver’s hands should be washed only after working with patients who are
thought to be infectious. d. the caregiver’s hands should be washed after touching any body fluids and
contaminated items regardless of whether gloves are worn. e. the caregiver’s hands should be washed only after touching body fluids with
ungloved hands and between patient contact. ANS: D
Hand washing should be done after removal of gloves, between patient contact, and after touching body fluids regardless of whether gloves are used. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross contamination of body parts.
REF: p. 31
TOP: Discipline: Pathophysiology
MSC: Organ System: General
4. Which patient is at the highest risk for the development of latex allergy? a. A new patient who has no chronic illness and has never been hospitalized b. A patient who has had multiple procedures or surgeries c. A patient who is allergic to eggs d. A patient who is allergic to contrast dye e. A patient who is a vegetarian ANS: B
A patient who has had multiple procedures or surgeries has a higher exposure rate to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. REF: p. 30
TOP: Discipline: Pathophysiology
MSC: Organ System: General
5. One recommendation to prevent latex allergy is to a. wear latex gloves frequently to reduce sensitivity. b. forcefully snap off examination gloves to remove excess powder from the gloves. c. wash hands with mild soap after removing gloves and then dry the hands
thoroughly. d. use well-powdered gloves with an increased protein content. e. use oil-based creams or lotions before donning gloves. ANS: C
The recommendations are to use nonlatex gloves for situations not likely to involve infectious materials, not to use oil-based creams or lotions, to wash hands with mild soap and dry thoroughly after removing gloves, and to use powder-free latex gloves with a reduced protein content. Forcefully snapping off latex gloves disperses latex molecules in the air, which can lead to the most severe reactions. REF: p. 32
TOP: Discipline: Pathophysiology
MSC: Organ System: General
6. Which patient position is useful for auscultating heart tones? a. Lithotomy b. Dorsal recumbent c. Left lateral recumbent d. Right Sims e. Prone ANS: C
The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. REF: p. 32
TOP: Discipline: Pathophysiology
MSC: Organ System: General
7. Which technique is used during the history taking and the physical examination process? a. Auscultation b. Instrumentation c. Palpation d. Percussion
e. Inspection ANS: E
Inspection is the technique used while gathering and validating data during the history taking and the actual hands-on physical examination. REF: p. 32
TOP: Discipline: Pathophysiology
MSC: Organ System: General
8. Which examination technique should be used first? a. Deep palpation b. Inspection c. Percussion d. Auscultation e. Light palpation ANS: B
Inspection, the process of systematic observation, is the first technique used in an examination. REF: p. 32
TOP: Discipline: Pathophysiology
MSC: Organ System: General
9. The use of secondary, tangential lighting is most helpful in the detection of a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. e. variations in texture and mobility. ANS: D
Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. REF: p. 33
TOP: Discipline: Pathophysiology
MSC: Organ System: General
10. A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having
drainage from his rectum. Which initial nursing action is appropriate? a. Drape the patient and observe the rectal area. b. Tell the patient that his physician will be notified of his problem. c. Tell the patient that you will ask the male nurse on the next shift to check on the problem. d. Give the patient an ice pack to apply to the area. e. Give the patient a specimen cup to collect the drainage. ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The complaint warrants validation before referring or delegating. REF: p. 33
TOP: Discipline: Pathophysiology
MSC: Organ System: General
11. You are conducting a head to toe examination as part of a patient’s preventive health
assessment. The room has adequate lighting, and you have access to both sides of the examining table. What position should you assume while conducting this examination? a. Behind the patient b. To the left side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient e. Standing in front of the patient ANS: D
Although conventionally taught to approach an examination from the patient’s right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. REF: p. 33
TOP: Discipline: Pathophysiology
MSC: Organ System: General
12. Which part of the examiner’s hand is best for palpating vibration? a. Dorsal surface b. The thumb c. Fingertips d. Ulnar surface and base of the fingers e. Finger pads ANS: D
The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus. REF: p. 33
TOP: Discipline: Pathophysiology
MSC: Organ System: General
13. The dorsal surface of the hand is most often used for the assessment of a. crepitus. b. thrills. c. texture. d. vibration. e. temperature. ANS: E
The dorsal surface, or back of the hand, can best feel for warmth. REF: p. 33
TOP: Discipline: Pathophysiology
MSC: Organ System: General
14. When conducting the abdominal examination, after you inspect, you proceed next to a. percussion. b. deep palpation. c. the rectal examination. d. auscultation. e. light palpation. ANS: D
Auscultation precedes palpation or percussion of the abdomen because these techniques can stimulate peristalsis, which may alter the correct assessment of abdominal sounds. The rectal examination is performed at a point after a full abdominal examination is completed.
REF: p. 35
TOP: Discipline: Pathophysiology
MSC: Organ System: General
15. The degree of percussion tone is determined by the density of the medium through which the
sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder the percussion tone. b. The less dense the medium, the louder the percussion tone. c. The more hollow the area percussed, the quieter the percussion tone. d. Percussion over bony areas produces the loudest percussion tones. e. Percussion tones are produced by the structure immediately beneath the skin. ANS: B
Percussion sounds vary according to the tissue being percussed. Whereas less dense tissue (e.g., over a normal lung) produces a loud tone, more dense tissue (e.g., a muscle) produces a softer tone. Percussion tones arise from vibrations 4 to 6 cm deep in the body tissue. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
16. Expected normal percussion tones include a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. e. resonance over the liver. ANS: C
Whereas a normal lung produces resonance percussion tones, an empty stomach is expected to produce tympany. Dull percussion tones are heard over the liver. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
17. When percussing, a dull tone is expected to be heard over a. most of the abdomen. b. emphysemic lungs. c. the liver. d. healthy lung tissue. e. an empty stomach. ANS: C
Dull tones are expected over more dense areas such as the liver. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
18. When using mediate or indirect percussion, which technique is appropriate? a. Place the palmar surface of the nondominant hand on the body surface with the
fingers held together. b. Place the palmar surface of the nondominant hand on the body surface with the fingers slightly spread apart. c. Mediate or indirect percussion involves striking the finger or hand directly against the body. d. Place the ulnar surface of the nondominant hand on the body surface with the
fingers slightly spread apart. e. Place the ulnar surface of the nondominant hand on the body surface with the fingers together. ANS: B
The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. To improve eliciting correct tones, a helpful tip is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint of the middle finger firmly against the body surface. This lifting of the fingertip avoids dampening the vibratory sounds. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
19. During percussion, the downward snap of the striking fingers should originate from the a. wrist. b. forearm. c. shoulder. d. interphalangeal joint. e. elbow. ANS: A
The dominant hand’s middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
20. Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or
kidneys? a. Finger percussion b. Only indirect percussion techniques are ever used to elicit tenderness. c. Fist percussion d. Thumb percussion e. Palmer percussion ANS: C
Fist percussion is a direct percussion technique used to elicit tenderness over organs such as the liver, gallbladder, or kidneys. REF: p. 34
TOP: Discipline: Pathophysiology
MSC: Organ System: General
21. During auscultation, you can limit your perceptual field best by a. asking patients to describe their symptoms. b. listening through the patient’s clothing. c. closing your eyes. d. performing palpation before percussion. e. turning out the lights in the examination room. ANS: C
By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds. REF: p. 35
TOP: Discipline: Pathophysiology
MSC: Organ System: General
22. You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty
distinguishing between respirations and heartbeats. What technique can you use to facilitate your assessment? a. Anticipate the next sounds. b. Isolate each cycle segment. c. Listen to all sounds together. d. Move the stethoscope clockwise. e. Ask the patient to whisper his or her name. ANS: B
If you are hearing everything at once, it is more difficult to distinguish different sounds. Try isolating each segment and listen to that segment intently; then move on to another segment. For example, listen only to breath sounds, then only to inspiratory breath sounds, and then only to expiratory breath sounds. REF: p. 35
TOP: Discipline: Pathophysiology
MSC: Organ System: General
23. When examining the abdomen, which technique should be used first? a. Inspection b. Light palpation c. Percussion d. Auscultation e. Direct palpation ANS: A
Inspection is always used as the first technique in all physical examinations, including the abdomen. REF: p. 32
TOP: Discipline: Pathophysiology
MSC: Organ System: General
24. Auscultation should be carried out last except when examining a. the neck area. b. the abdomen. c. the lungs. d. the heart. e. none of the above; auscultation is always carried out last in a proper physical
examination. ANS: B
Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. REF: p. 35
TOP: Discipline: Pathophysiology
MSC: Organ System: General
25. Which of the following statements is true regarding tympanic membrane temperature? a. It is taken by placing an infrared probe anterior to the ear. b. The probe is placed in the external auditory canal to occlude it. c. Temperatures taken with a tympanic thermometer never vary from those taken by
the oral or rectal route. d. It is an accurate measurement of body temperature because the tympanic
membrane shares its blood supply with the hypothalamus. e. It is taken by placing an infrared probe posterior to the ear. ANS: D
The tympanic membrane shares its blood supply with the hypothalamus and is therefore an accurate measurement of body temperature. Tympanic thermometer probes are gently placed at the external opening of the ear canal, but not in the canal, and they should not occlude the canal. REF: p. 39
TOP: Discipline: Pathophysiology
MSC: Organ System: General
26. A scale used to assess a patient’s weight should be calibrated a. when the patient tells you the weight is not correct. b. by a qualified technician at regularly scheduled intervals. c. each time it is used. d. when necessary, with the patient standing on the scale. e. only by the manufacturer. ANS: C
Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. REF: p. 37
TOP: Discipline: Pathophysiology
MSC: Organ System: General
27. The height-measuring attachment of the standing platform scale should be pulled out a. before the patient steps on the scale. b. before the scale is balanced. c. after the patient steps on the scale. d. while the weight is being determined. e. only after the weight has been assessed. ANS: A
To ensure patient safety, the arm of the height measuring attachment should be pulled up before the patient steps on the scale. REF: p. 37
TOP: Discipline: Pathophysiology
MSC: Organ System: General
28. An infant should be placed in which position to have his or her height or length measured? a. Vertical, with the examiner’s hands under the infant’s axilla b. Supine on a measuring board c. While being held by a parent d. In the lateral position with the toes against a measuring board e. Prone on a measuring board ANS: B
An infant should be placed supine on a measuring board to measure height or length. REF: p. 37
TOP: Discipline: Pathophysiology
MSC: Organ System: General
29. The stethoscope’s diaphragm is most useful in the assessment of _____ sounds. a. high-pitched b. dull
c. low-pitched d. rhythmic e. tympanic ANS: A
The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones. REF: p. 39
TOP: Discipline: Pathophysiology
MSC: Organ System: General
30. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell
endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece. c. Assessment findings are more accurate. d. Most sounds are occluded. e. Abnormally low sounds are better transmitted. ANS: B
Applying firm pressure to the bell endpiece causes the skin to act as a diaphragm, obliterating the low-pitched sounds. REF: p. 39
TOP: Discipline: Pathophysiology
MSC: Organ System: General
31. A rubber or plastic ring should be around the bell endpiece of a stethoscope to a. prevent the transmission of static electricity. b. avoid cold metal from touching the patient. c. prevent the sharp edge of the stethoscope from damaging the patient’s skin. d. allow firm pressure to be applied without discomfort. e. ensure secure contact with the body surface. ANS: E
The ring around the bell portion of the stethoscope functions to secure contact with body surfaces when placed lightly on the skin. REF: p. 40
TOP: Discipline: Pathophysiology
MSC: Organ System: General
32. Which technique should be used to stabilize the stethoscope during auscultation? a. The tubing should be held lightly near the endpiece. b. The tubing should be held firmly near the endpiece. c. The endpiece should be held between the second and third fingers. d. The endpiece should be covered with the examiner’s flattened hand. e. The endpiece should be held with all the examiner’s fingers. ANS: C
To stabilize the stethoscope at the desired location, the endpiece should be held in place with the second and third fingers. REF: p. 40
TOP: Discipline: Pathophysiology
MSC: Organ System: General
33. Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of
stethoscope?
a. b. c. d. e.
Diaphragm end of an acoustic stethoscope Electronic Ultrasonic Magnetic Bell end of an acoustic stethoscope
ANS: C
Only the ultrasonic stethoscope, the Doppler, can detect blood flow rather than amplify sounds, which is needed in assessing weak pulses, fetal heart activity, and vessel patency. REF: p. 41
TOP: Discipline: Pathophysiology
MSC: Organ System: General
34. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector
clockwise and then counterclockwise to compensate for a. amblyopia. b. astigmatism. c. cataracts. d. strabismus. e. myopia. ANS: E
Rotating the lens selector compensates for myopia (nearsightedness) and hyperopia (farsightedness) in the examiner and the patient. REF: p. 42
TOP: Discipline: Pathophysiology
MSC: Organ System: General
35. A patient in the emergency department has a concussion to the head. You suspect that the
patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient? a. Strabismoscope b. Red-free filter c. Slit lamp d. Small aperture e. Grid ANS: B
The red-free filter permits recognition of hemorrhages. The grid estimates the size of lesions, the slit lamp examines the anterior eye and assesses the elevation of lesions, and the small aperture is used with small pupils. The strabismoscope is used for detecting strabismus. REF: p. 42
TOP: Discipline: Pathophysiology
MSC: Organ System: General
36. The Tumbling “E” vision acuity chart would most likely be used for _____ patients. a. older b. infant c. pregnant d. preschool e. color-blind adult ANS: D
The E chart is used for children 3 to 5 years of age and others who do not know the alphabet. The examinee is asked which way the “E” points. REF: p. 43
TOP: Discipline: Pathophysiology
MSC: Organ System: General
37. Which type of speculum should be used to examine a patient’s tympanic membrane? a. The smallest speculum that will illuminate the ear b. The largest speculum that will fit comfortably in the ear c. The shortest speculum available d. Any speculum that will fit the otoscope head e. The longest speculum available ANS: B
To visualize the tympanic membrane adequately, the largest speculum that can comfortably fit in the car canal should be used. The other choices do not ensure greater visibility of the membrane and landmarks. REF: p. 45
TOP: Discipline: Pathophysiology
MSC: Organ System: General
38. The pneumatic attachment for the otoscope is used to evaluate a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. e. tympanic membrane temperature. ANS: D
The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement. REF: p. 45
TOP: Discipline: Pathophysiology
MSC: Organ System: General
39. The patient tells you that his ears are “stopped up.” An objective assessment of this complaint
is achieved by using a(n) a. nasal speculum. b. neurologic hammer. c. otoscope with pneumatic attachment. d. tympanometer. e. tuning fork. ANS: D
This patient is describing eustachian tube dysfunction. The tympanometer measures compliance of the middle ear as air pressures are varied. It is an objective means of assessing the function of the ossicular chain, eustachian tube, and tympanic membrane. REF: p. 45
TOP: Discipline: Pathophysiology
MSC: Organ System: General
40. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure a. vibratory sensations. b. hearing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level.
e. peripheral motor nerve damage. ANS: C
Normal speech has a range of 300 to 3000 Hz; therefore, a 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech. REF: p. 46
TOP: Discipline: Pathophysiology
MSC: Organ System: General
41. To perform a deep tendon reflex measurement, you should a. briskly tap the tendon with the rubber end of the hammer. b. place the hammer firmly on the tendon for 3 to 5 seconds. c. tap the silver end of the hammer on the tendon. d. use the needle implement to determine sensory perception. e. never use the pointed end to strike your finger placed over a tendon. ANS: A
Deep tendon reflexes are tested by quickly and firmly tapping either end of the rubber hammer on the stretched tendon and then observing muscle movement. The pointed end is particularly useful in small areas, such as on your finger placed over the patient’s biceps tendon. REF: p. 46
TOP: Discipline: Pathophysiology
MSC: Organ System: General
42. A variant of the percussion hammer is a neurologic hammer, which is equipped with which of
the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell e. Transilluminator ANS: A
A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached. REF: p. 46
TOP: Discipline: Pathophysiology
MSC: Organ System: General
43. When monitoring serial measurements, such as head circumference or abdominal girth, which
procedure is best to ensure that the tape measure is placed in the same position each time? a. Record the anatomic location for tape placement in the patient’s chart. b. Mark the borders of the tape at several intervals on the skin with a pen. c. Demonstrate proper tape placement to all members of the health care team. d. Ask the same person to perform the measurement each time. e. Ask the patient if the tape measure is on the same spot. ANS: B
The most effective procedure to ensure correct serial measurements is to mark the borders at several intervals so that with the next measurements, the tape is in the same location. REF: p. 47
TOP: Discipline: Pathophysiology
44. Transillumination functions on the principle that
MSC: Organ System: General
a. b. c. d. e.
infrared radiation is easily detected. black light causes certain substances to fluoresce. converging and diverging light brings structures into focus. tangential light casts shadows that illuminate contours. air, fluid, and tissue transmit light differentially.
ANS: E
Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. It consists of a strong light in the visible spectrum with a narrow beam. REF: p. 47
TOP: Discipline: Pathophysiology
MSC: Organ System: General
45. When performing transillumination of a body cavity, the use of which of the following could
be harmful to the patient? a. Penlight b. Performing the test in a darkened room c. Halogen bulb d. Otoscope light e. Flashlight ANS: C
A penlight, flashlight, or an otoscope light can safely be used; a halogen bulb can burn the skin. The test should be performed in a darkened room. REF: p. 47
TOP: Discipline: Pathophysiology
MSC: Organ System: General
46. For a woman with a small vaginal opening, the examiner should use a _____ speculum. a. plastic Graves b. Pederson c. pediatric d. nasal e. metal Graves ANS: B
The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrower and flatter and are therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic speculums are similar in use to their metal counterparts. REF: p. 47
TOP: Discipline: Pathophysiology
MSC: Organ System: General
47. You are performing a vaginal examination on a patient with a history of spina bifida. As you
insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation? a. Replace the metal speculum with a plastic one. b. Put a blanket over the patient’s legs. c. Remove the speculum. d. Take her blood pressure. e. Raise her legs above her heart. ANS: C
This patient is experiencing symptoms of autonomic hyperreflexia. The first reaction should be for the examiner to remove the source of the stimulation. Cold tables, stirrups, insertion of a speculum, and pressure during pelvic examinations are examples of stimulations. REF: p. 37
TOP: Discipline: Pathophysiology
MSC: Organ System: General
Chapter 04: Vital Signs and Pain Assessment Test Bank—Medical MULTIPLE CHOICE 1. Which of the following is a subjective measurement? a. Temperature b. Pulse c. Blood pressure d. Pain e. Respirations ANS: D
Pain is a subjective unpleasant symptom of many conditions and injuries. The pain experience and its characteristics and intensity are unique for each person. REF: p. 50
TOP: Discipline: Pathophysiology
MSC: Organ System: General
2. Body temperature is regulated by the a. thalamus. b. hypothalamus. c. medulla. d. pons. e. cerebellum. ANS: B
Body temperature is regulated by the hypothalamus. REF: p. 50
TOP: Discipline: Pathophysiology
MSC: Organ System: General
3. Which of the following is not involved in increasing body temperature? a. Pyrogens b. Vasoconstriction c. Shivering d. Vasodilation e. Prostaglandins ANS: D
Body cooling occurs by vasodilation, which increases heat loss through the skin and evaporation of perspiration. REF: p. 50
TOP: Discipline: Pathophysiology
4. The fifth vital sign is a. pain. b. orientation. c. waist-to-hip ratio. d. body mass index (BMI). e. weight. ANS: A
MSC: Organ System: General
Pain, the universal distress signal, is now recognized as the fifth vital sign. REF: p. 50
TOP: Discipline: Pathophysiology
MSC: Organ System: General
5. Which of the following is most closely related to damage or dysfunction of the central or
peripheral nervous system? a. Chronic pain b. Neuropathic pain c. Acute pain d. Acute inflammation e. Surgery ANS: B
Neuropathic pain is long-term pain associated with damage or dysfunction of the central or peripheral nervous system (e.g., amputation, complex pain syndrome). REF: p. 50
TOP: Discipline: Pathophysiology
MSC: Organ System: General
6. Nociceptors transmit pain impulses from the periphery along A-delta and C-polymodal fibers
to the a. posterior horn of the spinal cord. b. hypothalamus. c. cerebellum. d. dorsal horn of the spinal cord. e. pons. ANS: D
Pain impulses travel from the site of injury to the dorsal horn of the spinal cord and then through the ascending spinal tracts to the thalamus and cerebral cortex. REF: p. 51
TOP: Discipline: Pathophysiology
MSC: Organ System: General
7. Which of the following make infants more susceptible to hypothermia? a. Low body surface area for weight b. Thicker skin c. Limited ability to cope with cold stress d. Higher pulse rate e. Lower blood pressure ANS: C
Infants are more susceptible to hypothermia because of their large ratio of body surface area to weight, thinner skin, and limited ability to cope with cold stress. Infants have a higher pulse rate and lower blood pressure than adults, but this is unrelated to hypothermia. REF: p. 51
TOP: Discipline: Pathophysiology
8. The perception of pain: a. is the same across cultures. b. does not apply to neonates. c. is predictable with the same circumstances. d. is affected by emotions and quality of sleep. e. is not affected by age.
MSC: Organ System: General
ANS: D
The perception of pain is variable and is affected by emotions, cultural background, sleep deprivation, previous pain experience, and age. Perception of pain is different among cultures and does apply to neonates. REF: p. 51
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. A 5-year-old is complaining of nondescriptive “belly pain.” Your next action should be to ask
him to a. point a finger to the spot that hurts. b. draw a circle around the area that hurts. c. use a metaphor to describe the pain. d. identify what makes the pain worse. e. allow him to use a “pain-o-meter.” ANS: A
Asking the child to point to the area of pain can help communicate a more precise location. The other choices are not appropriate for the age of the child. REF: p. 60
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis
for which she is given antiinflammatory medication. To assess her right knee pain, you should ask her if a. the current pain is similar to previous pain. b. the left knee hurts as well. c. she took pain medication last night. d. the pain gets better when she sits. e. this is the worse pain she has ever had. ANS: D
You should refrain from asking older patients to compare past with present symptoms because recollection may be uncertain. It is more appropriate to ask a present-tense evaluation question, simply stated, without the addition of multiple factors to consider. REF: p. 60
TOP: Discipline: Behavioral Science
MSC: Organ System: General
11. During pregnancy, all of the following may be related to back pain except a. lax pelvic ligaments. b. weight gain. c. hyperlordosis. d. anterior tilt of the pelvis. e. lower blood pressure. ANS: E
Blood pressure commonly decreases beginning at about 8 weeks of gestation, gradually falling until a low point is reached at midpregnancy, but this is unrelated to the back pain some women experience during pregnancy. REF: p. 51
TOP: Discipline: Pathophysiology
MSC: Organ System: General
12. Which of the following is not related to older adults underreporting pain? a. They believe it is a normal part of aging. b. They have a diminished perception of pain. c. They do not want to be a nuisance. d. They believe reporting pain will lead to expensive testing or hospitalization. e. They are hesitant to take pain medications. ANS: B
No evidence exists that shows that older adults have a diminished capacity to perceive pain. REF: p. 52
TOP: Discipline: Pathophysiology
MSC: Organ System: General
13. Body language that leads you to suspect the person is in pain is a. talkative, verbose speech. b. fretful hand movements. c. focused, fixed eye stares. d. marked salivation. e. flushed, dry skin. ANS: B
A person in pain may suddenly become quiet; have an inability to keep the hands still; and have lackluster eyes, pallor, diaphoresis, pupil dilation, and a dry mouth. REF: p. 56
TOP: Discipline: Behavioral Science
MSC: Organ System: General
14. The value of the use of scales for patients to rate their pain intensity is that a. the emotional responses are factored in. b. correlation with others’ expectations is achieved. c. the patient’s response to therapy can be documented. d. subjective responses are eliminated. e. the patient’s perception is minimized. ANS: C
The use of scales permits the very important day to day documentation of the response to therapy. Although the patient’s perception is the controlling variable, the patient is still giving a subjective measurable response. REF: p. 56
TOP: Discipline: Behavioral Science
MSC: Organ System: General
15. A pain scale that is reliable and valid for children is the _____ scale. a. pain-o-meter b. pain-rating instrument c. numeric pain intensity d. Wong/Baker Faces Rating e. descriptive pain intensity ANS: D
The Wong/Baker Faces Rating Scale and the Oucher Scale are examples of pain scales that are reliable and valid for use with children. REF: p. 59
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. Which pulse is most commonly used to assess heart rate? a. Radial b. Brachial c. Dorsalis pedis d. Posterior tibial e. Popliteal ANS: A
The radial pulse is most often used to assess the heart rate. With the pads of your second and third fingers, palpate the radial pulse on the flexor surface of the wrist laterally. REF: p. 53
TOP: Discipline: Pathophysiology
MSC: Organ System: General
17. Which is the most reliable indicator of a patient’s pain? a. Facial grimacing b. Grunting or groaning c. Body movements d. Reluctance to be moved e. Patient’s report of the pain ANS: E
The patient’s report of pain is the most reliable indicator of pain and should be believed even when observed behaviors do not seem to correspond. REF: p. 56
TOP: Discipline: Pathophysiology
MSC: Organ System: General
18. Which of the following groups has the greatest variation in pulse rate? a. Toddlers b. Premature infants c. Neonates d. Adolescents e. Older adults ANS: B
The pulses of the newborn are easily palpable. Rates close to 200 beats/min may occur in neonates. REF: p. 57
TOP: Discipline: Pathophysiology
MSC: Organ System: General
19. The heart rate of a pregnant woman may increase to a level at term that is _____ higher than
normal. a. 5% to 10% b. 10% to 30% c. 40% to 60% d. 60% to 80% e. 80% to 100% ANS: B
The heart rate of a pregnant woman gradually increases throughout pregnancy until it is 10% to 30% higher at term. REF: p. 60
TOP: Discipline: Pathophysiology
MSC: Organ System: General
20. Hypertension in a pregnant woman (blood pressure reading greater than or equal to 160 mm
Hg systolic or 110 mm Hg diastolic) is one sign of a. a normal pregnancy. b. a nulliparous woman. c. preeclampsia. d. a multiparous woman. e. Braxton Hicks contractions. ANS: C
A gradual increase in blood pressure is common from the second to the third trimester. However, hypertension in this range may be a sign of preeclampsia. Braxton Hicks contractions are sporadic uterine contractions that start at around 6 weeks of pregnancy and are not associated with gestational hypertension or preeclampsia. REF: p. 60
TOP: Discipline: Pathophysiology
MSC: Organ System: General
21. Blood pressure may increase during the process of aging caused by a. increasing vagal tone. b. decreasing cardiac output. c. diminished tolerance to pain. d. increasing stiffness of the blood vessels. e. decreasing vascular resistance. ANS: D
During the process of aging the systolic blood pressure often increases because of increasing stiffness of the blood vessels and increased vascular resistance. Increasing vagal tone may decrease the pulse rate. REF: p. 60
TOP: Discipline: Pathophysiology
MSC: Organ System: General
22. A patient with trigeminal neuralgia would describe the pain as a. throbbing and dull. b. burning or shocklike. c. tender and deep. d. crushing and tearing. e. pressure or squeezing. ANS: B
Pain resulting from nerve tissue damage is described as having a burning, shocklike (electrical) quality. REF: p. 62
TOP: Discipline: Behavioral Science
MSC: Organ System: General
23. The nurse assesses the blood pressure to be 140/62 mm Hg and records 78 as the a. pulse pressure. b. pulse deficit. c. afterload pressure. d. preload pressure. e. stroke volume. ANS: A
The formula is: Systolic pressure – diastolic pressure = pulse pressure. Pulse deficit occurs when the number of pulse beats counted at the radial pulse is less than those counted at the same time at the heart. Afterload and preload are not measured according to blood pressures. Stroke volume cannot be determined from the blood pressure. REF: p. 50 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 24. The difference in blood pressure readings between the right and left arms is considered normal
up to _____ mm Hg. a. 5 b. 10 c. 20 d. 25 e. 30 ANS: B
Blood pressure readings between the left and right arms may vary by as much as 10 mm Hg and tends to be higher in the right arm. REF: p. 54 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 25. If only two blood pressure values are recorded, they are the _____ sounds. a. first systolic and first diastolic b. first systolic and second diastolic c. second systolic and first diastolic d. second systolic and second diastolic e. first and second diastolic. ANS: B
Phase 1 (systolic sound) and phase 5 (second diastolic sound) would be recorded if only two blood pressure values were used. REF: p. 54 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 26. A normal adult’s pulse pressure should range from _____ mm Hg. a. 10 to 20 b. 20 to 25 c. 30 to 40 d. 60 to 70 e. 80 to 100 ANS: C
An adult’s pulse pressure should range from 30 to 40 mm Hg and even as much as 50 mm Hg. Pulse pressure is the difference between the systolic and diastolic pressures. REF: p. 54 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
27. Postural hypotension is defined as which of the following when the patient stands compared
with a sitting or supine reading? a. Blood pressure drop of more than 20 mm Hg in systolic and 10 mm Hg drop in diastolic b. Pulse rate decrease with a systolic pressure increase of at least 15 mm Hg c. Diastolic pressure increase of more than 5 mm Hg and no pulse rate changes d. Pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg e. Decrease in pulse pressure ANS: A
Postural hypotension (orthostatic hypotension) represents a significant decrease in systolic pressure (greater than 20 mm Hg) and a 10–mm Hg drop in diastolic pressure as a patient changes from a sitting to a standing position. An increase in heart rate often occurs as well. REF: p. 55 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 28. The most frequent cause of serious hypertension in children is a. malnutrition. b. liver failure. c. renal disease. d. rheumatic fever. e. heart disease. ANS: C
Do not make the diagnosis of hypertension based on one reading. If the systolic blood pressure is elevated and the diastolic is not, anxiety may be responsible. Most children with a diagnosis of hypertension have an identifiable cause, usually renal disease. REF: p. 59 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 29. Which pulse is generally used to assess heart rate? a. Radial b. Brachial c. Dorsalis pedis d. Posterior tibial e. Popliteal ANS: A
The radial pulse is most often used to assess the heart rate. With the pads of your second and third fingers, palpate the radial pulse on the flexor surface of the wrist laterally. REF: p. 53
TOP: Discipline: Pathophysiology
30. A blood pressure cuff bladder should be long enough to a. cover 25% of the arm circumference. b. cover 50% of the arm circumference. c. cover 80% of the arm circumference. d. completely encircle the arm. e. wrap around the arm twice.
MSC: Organ System: General
ANS: C
The cuff bladder should be twice the width of the bladder or about 80% of the limb circumference. The bladder should not completely encircle the limb. REF: p. 54
TOP: Discipline: Pathophysiology
MSC: Organ System: General
31. If a sufficiently large cuff is unavailable to fit the arm of an obese person, which technique
may be used to assess blood pressure? a. Wrap a standard cuff around the deltoid area and place the stethoscope over the radial artery. b. Wrap a standard cuff around the forearm and place the stethoscope over the radial artery. c. Wrap a standard cuff around the thigh and place the stethoscope on the dorsalis pedis. d. Wrap a pediatric cuff around the ankle and place the stethoscope on the popliteal artery. e. Wrap a standard cuff around the forearm and place the stethoscope over the ulnar artery. ANS: B
Another technique to use when assessing the blood pressure of an obese person and you only have a standard adult cuff is to wrap the cuff around the smaller forearm and place the stethoscope over the radial artery. REF: p. 54
TOP: Discipline: Pathophysiology
MSC: Organ System: General
32. Systolic hypertension in the adult is generally defined as pressure in excess of a. 120 + the patient’s age. b. 140. c. 160. d. 180. e. 200. ANS: B
Hypertension continues to be defined as a blood pressure consistently at 140/90 mm Hg or higher. The equation that systolic blood pressure should be less than 120 + the patient’s age is no longer the acceptable definition. REF: p. 62 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
Chapter 05: Mental Status Test Bank—Medical MULTIPLE CHOICE 1. When is the mental status portion of the neurologic system examination performed? a. During the history-taking process b. Immediately after the vital signs are taken c. During the time when questions related to memory are asked d. Constantly, throughout the entire interaction with a patient e. During assessment of cranial nerves and deep tendon reflexes ANS: D
A mental status evaluation should be continually evaluated throughout the patient encounter. Assessing and validating clues to determine the individual’s ability to interact with the environment is a priority of the mental status evaluation. REF: p. 66
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
2. Which statement is true regarding mental status changes in older adults? a. There is usually a decline in general intelligence in older adults. b. Vocabulary and inventories of information show a marked decrease in older adults. c. Remote memory decline frequently causes problems in processing information. d. Recent memory is usually more efficient than remote memory. e. There is an increased risk of delirium with acute illness or metabolic derangement. ANS: E
Acute illness or metabolic derangement of older adults places such a stress on the declining metabolism and synthesis of neurotransmitters that adaptation is inadequate, and delirium results. None of the other statements are true. REF: p. 75
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
3. A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken
language. This indicates a lesion in the a. temporal lobe. b. Broca area. c. frontal cortex. d. precentral gyrus. e. occipital lobe. ANS: A
The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language. REF: p. 64
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
4. Slumped posture and a lack of facial expression may indicate depression or a. anxiety. b. Parkinson disease.
c. loss of abstract reasoning. d. attention-deficit/hyperactivity disorder. e. hyperthyroidism. ANS: B
A slumped posture and lack of facial expression may be clues to more than depression; they also are a defining characteristic of the neurologic disorder of known as Parkinson disease. REF: p. 67
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
5. The ability for abstract thinking normally develops a. in utero. b. during infancy. c. during early childhood. d. during adolescence. e. during adulthood. ANS: D
Abstract thinking is an intellectual maturation that develops during adolescence. REF: p. 64
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
6. The Mini-Mental State Examination (MMSE) a. may be used to estimate cognitive changes quantitatively. b. may be used to estimate personality disorders qualitatively. c. scores do not vary with regard to age or education. d. will determine the cause of memory loss. e. is a good tool to diagnose neurologic disorders. ANS: A
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to document cognitive changes serially. None of the other statements are correct. REF: p. 67
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
7. While interviewing a 70-year-old female clinic patient, she tells you that she takes ginkgo
biloba and St. John’s wort. You make a short note to check for results of the a. Denver II. b. Mini-Mental State Examination. c. Glasgow Coma Scale. d. Goodenough-Harris Drawing Test. e. CAGE Questionnaire. ANS: B
Ginkgo biloba and St. John’s wort are herbal remedies used to improve mental alertness and elevate mood. As side effects, they can also result in disorientation and confusion that can be monitored with the Mini-Mental State Examination. The Denver and Goodenough-Harris tests are used for childhood development, and the Glasgow Coma Scale is used to rate coma depth. The CAGE Questionnaire is a useful tool for approaching a discussion of the use of alcohol. REF: p. 67
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
8. Assessing orientation to person, place, and time helps determine a. the ability to understand analogies. b. abstract reasoning. c. attention span. d. state of consciousness. e. emotional status. ANS: D
Orientation to person, place, and time are measures of states of consciousness and awareness, not degrees of attention span. Analogies and abstract reasoning are higher functions than orientation. Emotional status can be better evaluated by observing behaviors. REF: p. 67
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
9. A state of impaired cognition, consciousness, mood and behavioral dysfunction of acute onset
refers to a. lethargy. b. delirium. c. stupor. d. coma. e. confusion. ANS: B
Delirium is a state of impaired cognition, consciousness, mood and behavioral dysfunction of acute onset. Stupor describes arousals for short periods of time after a stimulus for arousal (e.g., visual, verbal, or painful). Lethargy relates to sleepiness with ease of arousal; coma is nonarousal and nonawareness. Confusion relates to inappropriate responses to questions with decreased attention span and memory. REF: p. 75
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
10. Under most conditions, adult patients should be able to repeat a series of _____ numbers. a. two to three b. five to eight c. 10 to 15 d. 15 to 20 e. more than 20 ANS: B
Most adults should be able to recall immediately a series of five to eight numbers forward and four to six numbers backward. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
11. When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing
which of the following? a. Level of consciousness b. Abstract reasoning c. Emotional stability d. Memory e. Impaired judgment
ANS: B
Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the patient’s ability to reason abstractly. This intelligence test does not assess level of consciousness, emotional health, judgment, or memory. REF: p. 69
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
12. Impairment of arithmetic skills is often caused by a. impaired execution of motor skills. b. impaired judgment. c. peripheral neuropathies. d. depression. e. perceptual distortions. ANS: D
The patient with depression or diffuse brain disease can display difficulty with simple arithmetic calculations. This is not commonly seen with motor skill impairments, judgment impairments, or perceptual distortions and hallucinations. Peripheral neuropathies are best assessed by evaluating motor skills. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
13. Peripheral neuropathy is most likely to be manifested by a. impaired memory. b. impaired abstract reasoning. c. impaired writing ability. d. hallucinations. e. difficulties with analogies. ANS: C
Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy. REF: p. 70
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
14. Recent memory may be tested by a. asking the patient to do simple arithmetic. b. asking the patient to listen to and repeat a series of numbers. c. showing the patient four items and asking him or her to list the items about 10
minutes later. d. asking the patient about verifiable past events, such as his or her mother’s maiden
name. e. asking the patient to name the past four presidents. ANS: C
Showing the patient four or five objects, saying you will ask about them in a few minutes, and then 10 minutes later asking the patient to list the objects is a technique to measure recent memory. The other choices are not tests of recent memory. Asking the patient to listen and then repeat tests immediate recall. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
15. Loss of immediate and recent memory with retention of remote memory suggests a. attention-deficit/hyperactivity disorder (ADHD). b. impaired judgment. c. stupor. d. dementia. e. delirium. ANS: D
Dementia is the loss of immediate and recent memory while retaining remote memories. ADHD is associated with recent and remote memory impairment, impaired judgments are thought process dysfunctions, and stupor is impaired consciousness. Delirium manifests with confusion with disordered perceptions as well as motor and sensory excitement, with inappropriate reactions to stimuli. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
16. You ask the patient to follow a series of short commands to assess a. judgment. b. attention span. c. arithmetic calculations. d. abstract reasoning. e. emotional stability. ANS: B
A series of short commands for the patient to follow will test attention span rather than judgment, arithmetic calculations, abstract reasoning, or emotional stability. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
17. Which of these observations would be most significant when assessing the condition of a
patient who has judgment impairment? a. Repeated failure to complete work obligations b. Inadequate interpretation of a metaphor c. Going to church three times a week d. Planning for retirement in 20 years e. Forgetting family members’ birthdays ANS: A
Inadequately dealing with business affairs indicates impaired judgment; the other choices do not. REF: p. 70
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
18. Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the
assessment of a. mood and feelings. b. attention span. c. thought process and content. d. abstract reasoning. e. speech and language skills. ANS: C
Thought process and content are examined while observing the patient’s patterns of thinking, especially appropriateness of sequence, logic, coherence, and relevance to the topics discussed. REF: p. 71
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
19. Which type of hallucination is usually associated with alcohol withdrawal? a. Olfactory b. Visual c. Auditory d. Tactile e. Gustatory ANS: D
Tactile hallucinations are usually associated with alcohol withdrawal. REF: p. 72
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
20. Flight of ideas and loosening of associations are associated with a. Parkinson disease. b. dysphonia. c. multiple sclerosis. d. psychiatric disorders. e. aphasia. ANS: D
Flight of ideas, loosening of associations, word salad, neologisms, clang associations, echolalia, and utterances of unusual sounds are all associated with psychiatric disorders. REF: p. 72
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
21. Facial muscle or tongue weakness may result in a. aphasia. b. word salad. c. neologisms. d. echolalia. e. impaired comprehension. ANS: A
Aphasia can result from facial muscle or tongue weakness or from neurologic damage to the speech and language region of the brain. Neologisms (word choice based on sound so that words rhyme in a nonsensical way), word salad (meaningless, disconnected word choices), and echolalia (parrot speech) are coherence disturbances. REF: p. 71
TOP: Discipline: Neuroscience
22. The Glasgow Coma Scale is used to a. determine the cause of decreased consciousness. b. assess a patient’s level of abstract reasoning. c. quantify consciousness. d. predict response to stimulant medications. e. diagnose disorders that alter level of consciousness.
MSC: Organ System: Nervous
ANS: C
The Glasgow Coma Scale is used when a patient has an altered level of consciousness and is used to quantify consciousness. It cannot determine the cause of decreased consciousness, diagnose disorders, or predict responses to medications. Abstract reasoning is assessed by other methods. REF: p. 67
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
23. The examiner should be concerned about neurologic competence if a social smile cannot be
elicited by the time a child is _____ old. a. 3 days b. 2 weeks c. 1 month d. 3 months e. 6 months ANS: D
A social smile is expected in the 2- to 3-month-old infant. If it is difficult or impossible to elicit a social smile by 3 months, the infant may not be neurologically intact. REF: p. 72
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
24. The Denver II is a tool used to determine a. a child’s IQ. b. the child’s mood. c. whether a child is educable. d. whether a child is developing as expected. e. whether an adolescent is a suicide risk. ANS: D
The Denver II is a tool to determine whether a child is developing fine and gross motor skills, language, and personal–social skills as expected according to the child’s age. REF: p. 73
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
25. When the Goodenough-Harris Drawing Test is administered to a child, the evaluator
principally observes the a. presence and form of body parts. b. gender and race of the person drawn. c. approximate age and posture of the person drawn. d. length of time needed to draw a stick man. e. facial expressions of the child. ANS: A
The presence and form of body parts provide a clue about the child’s development when following the scoring criteria of the Goodenough-Harris Drawing Test. REF: p. 73
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
26. An older adult is administered the Set Test and scores a 14. The nurse interprets this score as
indicative of
a. b. c. d. e.
depression. cognitive impairment. delirium. schizophrenia. dementia.
ANS: E
Scores of less than 15 on this mental function test indicate dementia. REF: pp. 73-74
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
27. Which condition is considered progressive rather than reversible? a. Delirium b. Dementia c. Depression d. Anxiety e. Coma ANS: B
Dementia is considered progressive and irreversible, delirium and coma have the potential for reversal, and depression and anxiety are reversible. REF: p. 78
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
28. Which of the following is usually related to structural diseases of the brain? a. Delirium b. Dementia c. Depression d. Anxiety e. Psychosis ANS: B
One of the distinguishing characteristics that distinguishes dementia from the others is that it is usually related to structural diseases of the brain such as abnormal deposits , or recurrent strokes. REF: p. 78
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
29. Which statement is true in regard to attention-deficit/hyperactivity disorder (ADHD)? a. It occurs before 7 years of age. b. It is usually related to mental retardation. c. It is usually related to dementia. d. It is manifested by prolonged periods of catatonic behavior. e. It usually first manifests with decorticate posturing. ANS: A
ADHD occurs before 7 years of age, is not related to mental retardation or psychiatric disorders, and is not a form of dementia. Decorticate posturing in unresponsive patients indicates a significant lesion above the brainstem. REF: p. 77
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
30. An aversion to touch or being held, along with delayed or absent language development, is
characteristic of a. attention-deficit/hyperactivity disorder. b. autism. c. dementia. d. mental retardation. e. schizophrenia. ANS: B
Autistic disorder involves a combination of behavioral traits (e.g., lack of awareness of others, aversion to touch or being held, odd or repetitive behaviors, preoccupation with parts of objects) and communication deficits (usually echolalia [parrot speech]). REF: p. 78
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
31. You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is
apathetic and has disturbed thoughts and language patterns. The nurse recognizes this behavior pattern as consistent with a diagnosis of a. depression. b. autistic disorder. c. mania. d. schizophrenia. e. anxiety disorder. ANS: D
Autistic disorders are not psychotic disorders, and they usually begin before 3 years of age. Schizophrenia manifests as a psychotic disorder of early adult onset, with disturbances in language and speech, emotions, social withdrawal, and apathy. Depression, mania, and anxiety disorders may have speech disturbances but they are not hallmarks of these conditions. REF: p. 77
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
32. All of the following are usually associated with a neurochemical imbalance except a. schizophrenia. b. mania. c. anxiety disorder. d. autism. e. depression. ANS: D
Autism is a pervasive neurodevelopmental disorder of unknown etiology that has a strong genetic influence. All of the other disorders can be related to neurochemical imbalances in the brain. REF: p. 78
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
33. While interviewing a patient, you ask him to explain “a stitch in time saves nine” to assess a. reading comprehension. b. attention span. c. mood and feeling.
d. reasoning skills. e. perceptual distortions. ANS: D
Having the patient explain fables, proverbs, or metaphors determines abstract reasoning skills. REF: p. 69
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
34. The Mini-Mental State Examination should be administered for a patient who a. gets lost in her or his neighborhood. b. sleeps an excessive amount of time. c. has repetitive ritualistic behaviors. d. uses illegal hallucinogenic drugs. e. has a fear of leaving the house. ANS: A
The MMSE is a tool used to estimate cognitive function quantitatively or document cognitive changes serially. Getting lost in a familiar territory is a sign of possible cognitive impairment. REF: p. 69
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
Chapter 06: Growth and Measurement Test Bank—Medical MULTIPLE CHOICE 1. The gonads begin to secrete estrogen and testosterone during a. infancy. b. puberty. c. pregnancy. d. early childhood. e. early adulthood. ANS: B
At puberty, the gonads secrete testosterone and estrogen. As a result, secondary sex characteristics (e.g., genitalia growth) begin. Maturation occurs at a mean age of 14 years in females and 13 years in males. REF: p. 79
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
2. Developmental changes of puberty are caused mainly by the interaction of the pituitary gland,
gonads, and the a. hypothalamus. b. islet cells. c. thalamus. d. Wernicke area. e. thymus. ANS: A
Under the influence of the hypothalamus, pituitary gland, and gonads, developmental changes of puberty are established. The other choices do not play a part in maturation. REF: p. 94
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
3. After 50 years of age, stature a. becomes fixed. b. begins a barely perceptible secondary increase. c. increases at a rate of 0.5 cm/year. d. declines. e. declines and then begins a barely perceptible increase. ANS: D
As an individual reaches 50 years of age, the intervertebral disk begins to thin and become more compressed, which leads to a decline in stature. REF: p. 82 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 4. By 10 to 12 years of age, lymphatic tissues are about _____ adult size. a. 25% of b. 50% of
c. the same as d. twice the size as in e. five times the size as ANS: D
Lymphatic tissues are small compared to the total body size, but they are almost fully developed at birth. They grow fast and are about twice the adult size by 10 to 12 years of age. REF: p. 80 TOP: Discipline: Physiology MSC: Organ System: Hematopoietic/Lymphoid 5. Which organ(s) completes physical development more quickly than any other body part? a. Brain b. Kidneys c. Heart d. Lungs e. Lymphoid tissue ANS: A
Along with the skull, eyes, and ears, the brain completes development more quickly than any other part of the body; its most rapid growth occurs from conception to age 2 years. REF: p. 80
TOP: Discipline: Physiology
MSC: Organ System: Nervous
6. During adolescence, the head size normally increases as a result of a. sinus development. b. brain mass increase. c. evolution of lymphatic tissue. d. hypertrophy of glial cells. e. hypertrophy of myelin. ANS: A
As the facial sinuses grow, the head size enlarges its surface area to accommodate this growth. REF: p. 81
TOP: Discipline: Physiology
MSC: Organ System: General
7. Fifty percent of an individual’s ideal weight is gained during a. pregnancy. b. preschool years. c. adolescence. d. early adulthood. e. older adulthood. ANS: C
During adolescence, the trunk and legs grow the most, causing organs and the skeletal mass to double in size. During pregnancy, weight gain is accounted for by the growing fetus and pregnancy organs (placenta and uterus). In the preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In early adulthood, there is a reduction in size and weight. A decrease in weight for height and body mass index has been found with increasing age between 70 and 89 years of age. REF: p. 81
TOP: Discipline: Physiology
MSC: Organ System: General
8. Gender-specific skeletal differences first occur during a. the second stage of fetal development. b. late infancy. c. early childhood. d. adolescence. e. early adulthood. ANS: D
During adolescence, females develop wider pelvises, and males develop broad shoulders. Whereas males transition from a slight increase in body fat to more lean muscle mass in later puberty, females maintain an increase in adipose tissue throughout adolescence. REF: p. 80
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
9. The legs are the fastest growing body part during a. early infancy. b. late infancy. c. childhood. d. adolescence. e. early adulthood. ANS: C
The legs grow the fastest during childhood, the trunk grows fastest in infancy, and the skeletal muscles and organs grow fastest in early adulthood. REF: p. 81 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 10. Skeletal mass and organ systems double in size during a. infancy. b. early childhood. c. adolescence. d. early adulthood. e. mid life. ANS: C
During puberty, sex steroids stimulate secretion of growth hormone, causing the organs and skeletal mass to double in size. REF: p. 81 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 11. Achieving an optimal infant birth weight is difficult for pregnant adolescents because a. they have not completed their own growth spurt. b. there are insufficient uterine supporting structures. c. the amnionic fluid is variable in adolescents. d. blood volume has not reached adult proportions. e. most of the maternal tissue growth occurs in the third trimester. ANS: A
Pregnant adolescents younger than 16 years of age, or less than 2 years from menarche, may still be in their growth spurt. They may require higher weight gains during pregnancy to achieve an optimal infant birth weight. Maternal tissue growth accounts for most of the weight gain in the first and second trimesters. REF: p. 89
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
12. How much of the weight gained during a normal pregnancy is accounted for by an increase in
blood volume? a. Less than 1 pound b. 1 to 2 pounds c. 3 to 4 pounds d. 4 to 6 pounds e. 6 to 8 pounds ANS: C
An increase in blood volume usually accounts for 3-4 pounds of the weight gained during pregnancy. The remainder is due to the fetus and increases in maternal tissues (fluid volume, breasts, uterus, amniotic fluid, and increases in maternal fat and protein stores). REF: p. 81
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
13. During a preventive health care visit, Ms. G, an older patient, states that she is getting shorter.
She says that her son mentioned that her change in stature became noticeable to him during his last visit with her. Her posture appears straight and aligned. When addressing Ms. G’s present concerns, it is most important to inquire about a. number of pregnancies. b. parents’ height. c. history of scoliosis. d. approximate height at menarche. e. usual height and weight. ANS: E
Stature declines after 50 years of age because of progressive thinning of intervertebral disks, so it is important to determine the patient’s height and weight at this age as a baseline for future trends. REF: p. 82 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 14. Over the past 2 decades, there has been a trend toward a. preservation of weight. b. preservation of height. c. obesity in older adults. d. preservation of muscle mass. e. increase in size and weight of various organs in older adults. ANS: C
An increase in overweight and obese older adults has been documented over the past 15 to 20 years. A decrease in weight for height and body mass index has been found with increasing age in patients from 70 to 89 years of age. An age-associated reduction in size and weight of various organs has been identified, especially of the liver, lungs, and kidneys. REF: p. 82
TOP: Discipline: Physiology
MSC: Organ System: General
15. Milestone achievements are data most likely to appear in the history of a. adolescents. b. infants. c. school-age children. d. young adults. e. older adults. ANS: B
As part of the developmental assessment in infants, milestone achievements at certain ages, such as crawling, laughing, picking up the head, and turning over, are recorded. REF: p. 82
TOP: Discipline: Behavioral Science
MSC: Organ System: Nervous
16. Infants normally increase their birth length by ____% during the first year of life. a. 10 b. 25 c. 50 d. 100 e. 200 ANS: C
Infant length generally increases by 50% in the first year of life. REF: p. 84
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
17. Healthy term babies generally double their birth weight by what age? a. 1 month b. 3 months c. 5 months d. 9 months e. 12 months ANS: C
In general, healthy infants double their birth weight by 4 to 5 months of age and triple their birth weight by 12 months of age. Formula-fed infants are heavier after the first 6 months of life than breastfed infants; they grow faster in the first 6 months of life and experience slower growth in the second 6 months of the first year. REF: p. 84
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
18. Infants born to the same parents are normally within which range of weight of each other? a. 1 ounce b. 6 ounces c. 12 ounces d. 1 pound
e. 2 pounds ANS: B
Siblings born at term to the same parents usually weigh within 6 ounces of each other. REF: p. 83
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
19. You should measure the child’s head circumference at every health visit until at least age
_____ months. a. 3 b. 8 c. 12 d. 18 e. 24 ANS: E
Head circumference should be measured at every visit until 2 to 3 years of age. REF: p. 84
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
20. To measure head circumference, the tape is wrapped snugly around the child’s head at the
occipital protuberance and the a. supraorbital prominence. b. brow line. c. nasal bridge. d. chin. e. hairline. ANS: A
The measuring tape should be snugly wrapped around the child’s head at the occipital protuberance and the supraorbital prominence, thereby documenting the largest circumference. Care should be taken to ensure that the tape does not cut the skin. Make the reading to the nearest 0.5 cm or inch; remember to remeasure the head circumference at least once to check the accuracy of your measurement. REF: p. 84
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
21. Between 5 and 24 months of life, the infant’s chest circumference is normally a. about equal to the head circumference. b. greater than the head circumference by 2 inches. c. smaller than the head circumference by about 4 inches. d. at least 2 inches smaller than head circumference. e. none of the above; there is no relation between head and chest circumference
during this period. ANS: A
Between the ages of 5 months and 2 years, the infant’s chest circumference should closely approximate the head circumference; the ratio should be monitored so that microcephaly can be identified, if present. REF: p. 85
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
22. In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s a. length. b. weight. c. lung maturity. d. gestational age. e. future IQ. ANS: D
The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics, administered within 36 hours of birth, to confirm the newborn’s gestational age. REF: p. 85
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
23. The term large for gestational age (LGA) indicates that an infant is larger than ____% of
infants born at the same number of weeks’ gestation. a. 10 b. 25 c. 50 d. 75 e. 90 ANS: E
LGA corresponds to an infant who is in the greater than 90th weight percentile. REF: p. 86
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
24. The upper-to-lower segment ratio should be calculated a. bimonthly for the first year of life. b. annually for the first 5 years. c. only when a child is suspected of having a growth problem or unusual body
proportions. d. in children of first-generation immigrants. e. every 6 months for the first 24 months. ANS: C
The upper-to-lower ratio is assessed when a child is suspected of having a growth problem or unusual body proportions. REF: p. 87
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
25. An 11-year-old boy is brought in for an annual physical examination by his mother. You
suspect _____ when you measure his arm span at 65 inches and his height at 60 inches. a. premature pubarche b. hypothyroidism c. scoliosis d. Marfan syndrome e. dwarfism ANS: D
Arm span that is greater than a child’s height is associated with Marfan syndrome. These children can have cardiovascular problems and should be thoroughly evaluated.
REF: p. 87 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 26. Which of the following statements regarding female pubertal changes is true? a. Most adolescent girls develop breasts before pubic hair. b. Peak height velocity should occur after menarche. c. Breast asymmetry is an abnormal finding. d. Menarche should occur by Tanner breast stage B. e. Sexual maturation begins later in taller and heavier girls. ANS: A
In two-thirds of girls, breasts begin to develop before pubic hair. Peak height velocity actually occurs about 1 year before menarche, breast asymmetry is common, and menarche occurs after Tanner breast stage B. Sexual maturation begins earlier in taller and heavier girls. REF: p. 87
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
27. At what age does peak height growth velocity occur in boys? a. 6 years b. 10 years c. 12 years d. e.
13
years
15
years
ANS: D
Peak height velocity occurs at an average age of 13
years.
REF: p. 87 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 28. What is the youngest age at which pubic hair growth in a boy may be considered normal? a. 7 years b. 8 years c. 9 years d. 10 years e. 11 years ANS: C
In boys, sexual development before 9 years of age is precocious puberty and is considered an abnormal finding. REF: p. 89
TOP: Discipline: Physiology
MSC: Organ System: Endocrine
29. Which Tanner stage is marked by the most significant growth in penis length? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5 ANS: C
Tanner stage 3 is marked by enlargement of the penis, especially in length. REF: p. 90
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
30. Which breast Tanner stage corresponds to a secondary areola mound development above the
breast? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5 ANS: D
Tanner stage 4 depicts the stage in which the areola forms a second mound above the breast. REF: p. 88
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
31. A woman with a normal prepregnancy body mass index (BMI) should gain approximately
_____ pounds during pregnancy. a. 10 b. 15 c. 20 d. 30 e. 40 ANS: D
Women of normal BMI should expect to gain between 25 and 35 pounds during pregnancy. REF: p. 89
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
32. A pregnant woman of normal prepregnancy weight should be expected to gain how much
weight per week during the second and third trimesters of pregnancy? a.
pound
b. 1 pound c.
1
pounds
d. 2 pounds e.
2
pounds
ANS: B
Expected weight gain in the first trimester is variable, between 1 and 2 kg (2 to 4 pounds); however, in the second and third trimesters, weekly weight gain should be approximately 0.45 kg (1 pound) per week. REF: p. 90
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
33. Frontal skull bossing, cranial ridges, mandibular overgrowth, and maxillary widening are
characteristics of a. infantile hydrocephalus. b. acromegaly. c. Cushing syndrome.
d. achondroplasia. e. Turner syndrome. ANS: B
These presenting features are all prominent characteristics of acromegaly; teeth separation and malocclusion can result from the maxillary widening. REF: p. 92
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
34. A round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical
area are associated with a. infantile hydrocephalus. b. hypopituitary dwarfism. c. Cushing syndrome. d. achondroplasia. e. acromegaly. ANS: C
These are all commonly associated characteristics of Cushing syndrome, with the buffalo hump as a distinguishing feature. REF: p. 92
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
Chapter 07: Nutrition Test Bank—Medical MULTIPLE CHOICE 1. Which of the following is a macronutrient? a. Iron b. Thiamine c. Calcium d. Fat e. Alcohol ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. Even though alcohol also provides calories, it is not required for any physiologic process by the body. REF: p. 95
TOP: Discipline: Physiology
MSC: Organ System: General
2. Macronutrients are so named because they a. have high molecular weights. b. form long chemical chains. c. tend to increase the waist measurements. d. are the main source of calories. e. are not stored in the body. ANS: D
Carbohydrates, protein, and fat are referred to as macronutrients because they are the main source of calories in the diet. REF: p. 95
TOP: Discipline: Physiology
MSC: Organ System: General
3. Carbohydrate stored in the liver and muscle can provide energy for moderate activity for
about a. 2 hours. b. 6 hours. c. 13 hours. d. 24 hours. e. 3 days. ANS: C
About 365 g is stored as glycogen in the liver and muscle tissues, which provides energy for only about 13 hours of moderate activity. Moderate amounts of carbohydrate must be ingested at frequent intervals to meet the energy demands of the body. REF: p. 95
TOP: Discipline: Physiology
4. The body handles excess carbohydrate ingestion by a. increasing muscle production. b. raising the metabolic rate.
MSC: Organ System: General
c. excreting it in urine and stool. d. enzyme degradation. e. storing it as fat. ANS: E
Excess carbohydrates, not used for fueling the body’s demands, are stored in fatty tissues. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
5. A college student comes to the student health center complaining of difficulty in concentrating
during class and while studying. The diet that would contribute to this problem is one that includes mostly a. fruit and vegetables. b. lean meat and fish. c. sandwiches and diet drinks. d. pasta and chicken. e. cereal and breads. ANS: B
Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. REF: p. 95
TOP: Discipline: Physiology
MSC: Organ System: General
6. One g of carbohydrate supplies how many calories? a. 1 b. 2 c. 4 d. 6 e. 10 ANS: C
Carbohydrates provide 4 calories per gram. REF: p. 95
TOP: Discipline: Physiology
MSC: Organ System: General
7. Which of the following is a major function of dietary protein? a. Provides energy source for brain b. Builds and maintains tissues c. Participates in specific detoxifying metabolic pathways d. Synthesizes and regulates of hormones e. Transmits nerve impulses ANS: B
The major functions of proteins include building and maintaining tissues; regulating water and acid-base balance, and acting as a precursor for enzymes, antibodies, and several hormones. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
8. The recommended minimum daily protein requirement for an normal adult is a. 20 g. b. 10% to 35% of total calories.
c. 90 g. d. 35% to 45% of total calories. e. 50% to 60% of total calories. ANS: B
The recommended protein content of the diet for adults is 10% to 35% of total calories, with a Recommended Daily Allowance (RDA) goal of 46 g in adult women and 56 g in adult men. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
9. Advising a person to reduce which of the following will produce the greatest caloric reduction
per gram of reduction? a. Carbohydrate b. Protein c. Fat d. Fiber e. All provide the same number of calories per gram. ANS: C
Whereas carbohydrates and proteins supply 4 calories per gram, fats supply 9 calories. Fiber is a complex carbohydrate and therefore supplies 4 calories per gram. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
10. Linoleic acid, a major fatty acid, is thought to be essential for a. energy metabolism. b. normal growth and development. c. myocardial cell function. d. regulation of memory retrieval. e. carbohydrate storage. ANS: B
Linoleic acid, found abundantly in milk and dairy fats, is required for normal growth and development. Recently, it has been suggested that it can to reduce body fat in overweight persons, and it also has cancer-fighting properties. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
11. A deficiency of vitamin ___, a fat-soluble micronutrient, can result in rickets. a. A b. E c. B1 d. K e. D ANS: E
Diets deficient in vitamin D can cause rickets. Today, milk is fortified with vitamin D; therefore, rickets is seldom seen in the United States. REF: p. 103
TOP: Discipline: Physiology
MSC: Organ System: General
12. Which B vitamin is deficient in patients with pernicious anemia?
a. b. c. d. e.
B1 B2 B6 B9 B12
ANS: E
Pernicious anemia can result in vitamin B12 deficiency. REF: p. 104
TOP: Discipline: Physiology
MSC: Organ System: General
13. Deficiency of which micronutrient is implicated in osteoporosis? a. Phosphorus b. Calcium c. Iron d. Zinc e. Selenium ANS: B
Ninety-nine percent of bone is composed of calcium. A deficiency in calcium would lead to the fragile bone condition called osteoporosis. REF: p. 105
TOP: Discipline: Physiology
MSC: Organ System: General
14. Which of the following assessment findings might lead the examiner to suspect vitamin D
deficiency? a. Cranial bossing and bowed legs b. Night blindness and decreased hearing c. Headaches and seizures d. Nausea and dizziness e. Cardiomyopathy ANS: A
Vitamin D deficiency can lead to rickets, a disease manifested by skeletal problems such as cranial bossing and bowed legs. REF: p. 103
TOP: Discipline: Physiology
MSC: Organ System: General
15. Which of the following is the most vital nutrient? a. Protein b. Carbohydrate c. Fat d. Water e. Vitamins ANS: D
A person can exist without food or vitamins for several weeks but without water for only a few days. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
16. Which of the following should be assessed first in a patient with sustained rapid respirations?
a. b. c. d. e.
Diet history Triceps skinfold thickness Mid-upper arm circumference Weight Body mass index
ANS: D
A person hyperventilating would lose more insensible water, increasing the risk for dehydration. The most sensitive and rapid assessment tool is to weigh the patient to determine loss of fluids. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
17. Under normal circumstances, how much water is lost daily by the body? a. 1 to 1.5 L b. 2 to 2.5 L c. 3 to 3.5 L d. 5 to 6.5 L e. 7 to 8.5 L ANS: B
Approximately 2 to 2.5 L of water is lost daily. REF: p. 96
TOP: Discipline: Physiology
MSC: Organ System: General
18. The largest proportion of total energy expenditure by the body is through a. thermogenesis. b. digestive processes. c. resting energy. d. physical activity. e. hyperventilation. ANS: C
Resting energy expenditure contributes the largest proportion of total energy expenditure by the body. REF: p. 97
TOP: Discipline: Physiology
MSC: Organ System: General
19. Which of the following is the most accurate reflection of an individual’s food intake? a. 24-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assays e. Comparing the individual’s intake with the MyPlate.gov website. ANS: B
A food diary is recorded as it happens, making this method the most accurate reflection of an individual’s food intake. REF: p. 101
TOP: Discipline: Physiology
MSC: Organ System: General
20. You are using a rule of thumb for advising a 150-pound person regarding the appropriate
number of calories to promote weight loss. Your advice is for the person to consume no more than _____ calories per day. a. 1500 b. 1700 c. 1900 d. 2100 e. 2500 ANS: B
The person weighs 68 kg, which multiplied by 25 (rule of thumb for weight loss) equals 1700 calories. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
21. Deficiency of which of the following is a concern in the vegetarian diet? a. Ascorbic acid b. Vitamin B12 c. Folate d. Carbohydrates e. Vitamin K ANS: B
The nutrients that may be deficient in a vegetarian diet if not carefully planned include proteins, calcium, iron, vitamin B12, and vitamin D. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
22. When using rule of thumb estimates of energy needs of healthy adults, how many kilocalories
per kilogram (kcal/kg) are required to maintain an individual’s current weight? a. 10 b. 20 c. 30 d. 40 e. 50 ANS: C
The requirement for weight maintenance is 30 kcal/kg. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
23. Which age group has the lowest daily fat intake recommendation? a. Infants and children up to 2 years of age b. Children between 2 and 10 years of age c. Adolescents d. Young adults e. Older adults ANS: E
Recommendations for daily fat intake decreases with age. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
24. What percentage of daily calories should be from fat in an adult? a. 10% to 25% b. 20% to 35% c. 30% to 45% d. 40% to 55% e. 60% to 75% ANS: B
Adults should have 20% to 35% of daily calories from fat. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
25. What age group should have less than 10% of calories come from saturated fat? a. Infants b. Children c. Adolescents d. Adults e. All age groups ANS: E
For all ages, less than 10% of calories should be from saturated fat. REF: p. 102
TOP: Discipline: Physiology
MSC: Organ System: General
26. Which medication is frequently associated with weight gain? a. Diuretics b. Oral hypoglycemics c. Laxatives d. Steroids e. Antibiotics ANS: D
Medications that contribute to weight gain include steroids, oral contraceptives, antidepressants, and insulin. REF: p. 97 TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: General 27. A major risk factor for developing an eating disorder is having a. parents who stress academia and social acceptance. b. a first-degree relative with an eating disorder. c. siblings who are low academic achievers. d. parents who stress the importance of the food pyramid. e. parents in a lower socioeconomic group. ANS: B
A major risk factor for an eating disorder is having a family history of eating disorders, especially in a first-degree relative. REF: p. 99
TOP: Discipline: Behavioral Science
MSC: Organ System: General
28. An extremely obese adult would have a BMI greater than a. 20. b. 25. c. 30. d. 35. e. 40. ANS: E
Adult classification of BMI for obesity is overweight, 25 to 29.9; obesity, 30 to 39.9; and extreme obesity, above 40. REF: p. 110
TOP: Discipline: Physiology
MSC: Organ System: General
29. Monitoring a patient’s waist-to-hip ratio provides data concerning: a. daily caloric requirements. b. lung capacity. c. stomach cancer risk. d. cardiovascular disease risk. e. developing an eating disorder. ANS: D
Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular disease. REF: p. 100
TOP: Discipline: Physiology
MSC: Organ System: General
30. A 17-year-old girl presents to the clinic for a sport’s physical examination. Physical
examination findings reveal salivary gland enlargement , multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she a. binges and vomits. b. has regular menstrual periods. c. has constipation frequently. d. is cold intolerant. e. has bloating. ANS: A
Young adults, usually young women, who have salivary gland enlargement, knuckle scars and tooth decay as a result of chronic self-induced vomiting characterize bulimia. Amenorrhea can be from increased physical activity or anorexia; constipation, bloating, and cold intolerance are usually symptoms of anorexia nervosa. REF: p. 112
TOP: Discipline: Behavioral Science
MSC: Organ System: General
31. Which of the following characteristics can distinguish patients with anorexia from those with
bulimia? a. Adolescent and young adult women are affected. b. Patients may exercise excessively to lose weight. c. Patients become malnourished. d. Patients may abuse laxatives and diuretics. e. Patients have amenorrhea. ANS: C
Bulimic individuals usually do not become malnourished (as occurs with anorexic patients) unless they drop to less than 85% of their weight. REF: p. 112
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 08: Skin, Hair, and Nails Test Bank—Medical MULTIPLE CHOICE 1. The skin repairs epidermal wounds by a. exaggerating cell replacement. b. excreting lactic acid. c. producing vitamins. d. providing a mechanical barrier. e. increasing the vascularity of the epidermis. ANS: A
The skin’s tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition. REF: p. 115 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 2. The adipose tissue in the hypodermis serves to a. provide sensory input. b. generate heat and insulate. c. create tensile strength. d. restrict water loss. e. secrete collagen. ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories. REF: p. 115 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 3. Sweat glands, hair, and nails are all formed from a. basement membranes under cellular strata. b. closely packed squamous cells. c. invaginations of epidermis into dermis. d. papillae that penetrate the epidermis. e. evaginations of the hypodermis. ANS: C
Skin appendages are formed embryonically when the epidermis invaginates into the dermis. REF: p. 115 TOP: Discipline: Embryology MSC: Organ System: Skin/Connective 4. The secretory activity of the sebaceous glands is stimulated by a. body heat. b. ambient temperature. c. sex hormones.
d. dietary protein. e. emotional stimuli. ANS: C
The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a lipid-rich substance that keeps the skin moist. REF: p. 116 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 5. Which structure is the site of new nail growth? a. Cuticle b. Paronychium c. Eponychium d. Nail bed e. Matrix ANS: E
The white, crescent-shaped area beyond the proximal nail fold (lunula) is the distal end of the nail matrix, which is the site of new nail growth. REF: p. 116 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 6. Newborns are more vulnerable to hypothermia because of a. the presence of coarse terminal hair. b. desquamation of the stratum corneum. c. their covering of vernix caseosa. d. a poorly developed subcutaneous fat layer. e. excessive secretion of eccrine sweat glands. ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat and become insulated from the environment. The eccrine sweat glands do not begin to function until after the first month of life. REF: p. 116 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 7. Normal hormone-related changes of adolescence include a. increased oil production. b. the development of fine silky lanugo hair. c. depletion of apocrine glands. d. decreased sebaceous gland activity. e. slowed hair growth. ANS: A
During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne. REF: p. 116 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective
8. Expected hair distribution changes in the older adults include a. increased terminal hair follicles to the scalp. b. more prominent axillary and pubic hair production. c. increased terminal hair follicles to the tragus of men’s ears. d. more prominent peripheral extremity hair production. e. women possibly developing less coarse facial hair. ANS: C
The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus. REF: p. 117 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 9. Brittle nails are typical findings in a. adolescents. b. infants. c. pregnant women. d. older adults. e. children. ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails characteristically to develop longitudinal ridges that are more brittle and susceptible to splitting into layers. REF: p. 117 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 10. The nails of older adults grow slowly because of a. decreased circulation. b. dietary deficiencies. c. fungal infections. d. low hormone levels. e. high estrogen levels. ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation. REF: p. 117 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 11. Risk factors for skin cancer include a. an olive complexion. b. repeated trauma or irritation to the skin. c. a history of allergic reactions to sunscreen. d. dark eyes and hair. e. pigmented bands in the nails. ANS: B
Fair-skinned persons with light-colored eyes and repeated trauma or skin irritation are at have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals. REF: p. 117 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 12. Which of the following, if reported, belongs in the family history of a patient with a skin rash? a. Father has chronic asthma. b. Sister repeatedly uses a tanning booth. c. Mother trims patient’s nails too short. d. Sister had measles as a child. e. Grandparent had chemical burn. ANS: A
Asthma and many dermatologic findings have shared atopic (allergic) qualities. REF: p. 118 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 13. The type and brand of grooming products used are important to the health history of a. adolescents. b. everyone. c. older adults. d. persons with rashes. e. children. ANS: B
Knowledge of exposure to environmental chemicals is valid health history data for all age groups. REF: p. 119 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 14. Inspection to determine color variations of the skin is best conducted: a. using an episcope. b. under fluorescent lighting. c. with illumination provided by daylight. d. using a Wood’s lamp. e. using a pen light. ANS: C
Daylight provides the best illumination source for determining color variations of the skin. REF: p. 119 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 15. Tangential lighting is best used for inspecting skin a. color. b. turgor. c. exudates. d. symmetry.
e. contour. ANS: E
Tangential lighting, light shined laterally to the surface, is best for inspecting skin contours. REF: p. 120 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 16. Unusual white areas on the skin may be caused by: a. adrenal disease. b. polycythemia. c. vitiligo. d. Down syndrome. e. lentigo. ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo. REF: p. 122 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 17. Pigmentary demarcation lines are a. a precursor of skin cancer b. more common on people with fair skin c. commonly seen on the face d. a normal variation e. may decrease during pregnancy ANS: D
Pigmentary demarcation lines are a normal variation. They mark the border between deeply pigmented skin and lighter pigmented skin. They are most commonly seen on the arms, legs, chest, and back and have been reported most often in black and Japanese populations. Accentuation of preexisting lines or appearance of new lines may occur during pregnancy They are not a precursor of skin cancer. REF: p. 121 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 18. Which cultural group has the lowest incidence of nevi? a. Native Americans b. African Americans c. Mexican Americans d. Asians e. Eastern Europeans ANS: B
Nevi are more common in persons who burn rather than tan; therefore, African Americans have the lowest rates of nevi. REF: p. 121 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
19. Pale, shiny skin of the lower extremities may reflect a. excessive steroids. b. a history of vigorous exercise. c. peptic ulcer disease. d. vasculitis. e. systemic disease. ANS: E
Pale, shiny skin of the lower extremities may reflect peripheral changes that occur with systemic disorders, such as diabetes mellitus and cardiovascular disease. REF: p. 123 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 20. A 29-year-old white woman appears jaundiced. A cause of liver disease has been excluded.
What history questions should the nurse ask? a. Whether she had unprotected sex b. If she has a history of diabetes mellitus c. Whether she has unusual bleeding problems d. If she eats a lot of yellow and orange vegetables e. If she has a family history of peripheral vascular disease ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced. REF: p. 123 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 21. The nurse blanches over a vascular lesion on a pregnant patient. The site blanches and refills
evenly from the center outward. The nurse documents this lesion as a. telangiectasia. b. a spider angioma. c. petechiae. d. purpura. e. ecchymosis. ANS: B
Spider angiomas are dilated arterioles. A network of dilated capillaries radiates from the center arteriole, outward like a spider’s legs. Spider angiomas are often associated with high estrogen levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Whereas telangiectases refill erratically, petechiae, purpura, and ecchymoses do not blanch. REF: p. 123 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 22. Small, less than 0.5-cm in diameter, red-purple nonblanchable discolorations of the skin are a. ecchymoses. b. petechiae. c. spider veins.
d. telangiectasias. e. purpura. ANS: B
Petechiae are red-purple, nonblanchable discolorations less than 0.5 cm diameter. They are frequently caused by intravascular defects or infections. REF: p. 124 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 23. A flat, nonpalpable lesion is described as a macule if the diameter is a. greater than 1 cm. b. less than 1 cm. c. greater than 2 cm. d. too irregular to measure. e. exactly 5 mm. ANS: B
A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles. REF: p. 126 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 24. A 4 3-cm, rough, elevated area of psoriasis is an example of a a. plaque. b. patch. c. macule. d. papule. e. wheal. ANS: A
A plaque by definition is an elevated, firm, rough lesion with a flat-topped surface larger than 1 cm in diameter. An example is psoriasis. REF: p. 126 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 25. The nurse inspects an annular lesion. What type of additional lighting source should be used
for further assessment? a. Florescent lighting b. Wood’s lamp c. Goose-neck lamp d. Sunlight e. Cobalt blue ANS: B
Annular lesions are characteristic of tinea, which are fluorescing lesions that illuminate as yellow-green under a Wood’s lamp. REF: p. 133 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective
26. Skin turgor checks are performed to determine a. the temperature of the skin. b. hydration status. c. skin texture. d. the extent of an ecchymosis. e. skin moisture. ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present. REF: p. 140 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 27. Skin lesions are transilluminated to determine a. vascular from nonvascular lesions. b. furuncles from folliculitis lesions. c. fluid-filled lesions in solid cysts or masses. d. herpes zoster from varicella. e. macules from papules. ANS: C
Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions transilluminate with a red glow, but solid masses do not transilluminate. This technique does not differentiate the other choices. REF: p. 133 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 28. Fluorescing lesions are best distinguished using a(n) a. incandescent lamp. b. magnifying glass. c. transilluminator. d. Wood’s lamp. e. halogen lamp. ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a Wood’s lamp. REF: p. 133 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 29. Women with terminal hair growth in a male distribution pattern should receive further
evaluation for a(n) a. circulation condition. b. gastrointestinal disorder. c. inflammatory state. d. nutritional deficit. e. endocrine disorder. ANS: E
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of an endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or nutritional deficits. REF: p. 134 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 30. The nurse assesses the patient’s nails and finds transverse white bands that cover the nail
except for a narrow zone at the distal tip. Additional physical examination of this patient should include a. palpation of the liver. b. auscultation for carotid bruits. c. inspection for jaundice. d. fist percussion of the kidney. e. chest percussion. ANS: C
White banding of this nature describes Terry nails, which are usually associated with cirrhosis and hypoalbuminemia. Cirrhosis results in jaundice (icterus). The liver is scarred but not generally enlarged; carotid bruits and lung and kidney involvement are not directly related. REF: p. 158 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 31. The nurse assesses the nail base angle using the Schamroth technique. The normal expected
examination finding is nail beds that are _____ at the bases. a. flat b. convex c. concave d. bowed e. elevated ANS: C
The normal nail base angle should be 160 degrees, which results in a concave nail base that produces a diamond-shaped window with the Schamroth technique. REF: p. 135 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 32. Which nail change found on examination would be most alarming? a. Dark bands seen in all fingernails of a dark-skinned person b. A yellow discoloration of the great toe of an older adult c. A single blue nail d. Pits in both index fingernails of an adult e. Longitudinal ridges in an older adult ANS: C
Dark bands in a dark-skinned person are normal, yellow in the toe of an older adult can be a nail disease or a chronic respiratory condition, and pits are related to psoriasis. Longitudinal ridges are a common expected variation. A single blue or black nail may indicate melanoma. REF: p. 134
TOP: Discipline: Pathophysiology
MSC: Organ System: Skin/Connective 33. Transient mottling of the patient’s skin in a cool room is a common finding in a. menopausal women. b. newborn infants. c. pregnant women. d. sedentary adults. e. older adults. ANS: B
Cutis marmorata, a mottled appearance, is part of a newborn’s response to changes in temperature. REF: p. 138 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 34. A single transverse crease seen on the palm of a small child may imply a. Down syndrome. b. Turner syndrome. c. systemic sclerosis. d. profound dehydration. e. neurofibromatosis. ANS: A
A single transverse crease is seen on the palm of children with Down syndrome. REF: p. 138 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 35. Café au lait patches are numbered with each assessment of infants and young children because a. their numbers are expected to increase each year. b. coalescent lesions are a more serious finding. c. the presence of more than six patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. e. a higher number correlates with the development of erythema toxicum. ANS: C
The presence of more than six patches with diameters of more than 5 mm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches are usually considered harmless. REF: p. 139 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 36. A Dennie-Morgan fold is probably caused by a. birth trauma. b. high fever. c. excess adipose tissue. d. kidney disease. e. chronic rubbing. ANS: E
Persons with chronic atopic or allergic conditions tend to rub their eyes so much that it causes an extra crease or pleat of skin below the eye, called the Dennie-Morgan fold. REF: p. 140 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 37. Linea nigra is commonly found on the abdomens of a. newborns. b. infants and children. c. adolescents. d. pregnant women. e. older adults. ANS: D
Pregnant women commonly develop pigmentation of the abdomen from the symphysis pubis to the top of the fundus in the midline. REF: p. 140 TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 38. Cherry angiomas are a common finding in a. adults older than 30 years. b. newborns. c. pregnant women. d. sunbathers. e. adolescents. ANS: A
Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age. REF: p. 142 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 39. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced
practitioner who can distinguish a. cutaneous tags from lentigines. b. furuncles from folliculitis. c. sebaceous hyperplasia from eczema. d. seborrheic keratoses from actinic keratoses. e. herpes zoster from varicella. ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination. REF: p. 142 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 40. Which decubitus ulcer stage indicates damage into the subcutaneous tissue? a. Stage I b. Stage II
c. Stage III d. Stage IV e. Stage V ANS: C
Stage III describes damage through to the subcutaneous tissue. The staging of decubitus ulcers consists of only four stages. REF: p. 142 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 41. Age spots are also called a. seborrheic keratoses. b. senile lentigines. c. cutaneous horns. d. acrochordon. e. cutaneous tags. ANS: B
Senile lentigines are irregular, round, gray-brown lesions with a rough surface that occur in sun-exposed areas and are referred to as age spots. REF: p. 143 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 42. The most common inflammatory skin condition is a. cutis marmorata. b. eczematous dermatitis. c. intradermal nevus. d. pityriasis rosea. e. psoriasis. ANS: B
The most common inflammatory skin disorder is eczematous dermatitis. Cutis marmorata and nevi are not inflammatory conditions, pityriasis rosea is not as common as eczema, and psoriasis is a disease of keratin synthesis. REF: p. 144 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 43. Which of the following is a noncandidal fungal infection? a. Pityriasis rosea b. Psoriasis c. Milia d. Rosacea e. Tinea corporis ANS: E
Tinea corporis is the only listed fungal infection (noncandidal); the others are not fungal in origin. REF: p. 146
TOP: Discipline: Pathophysiology
MSC: Organ System: Skin/Connective 44. The characteristic that best differentiates psoriasis from other skin abnormalities is the a. color of the scales. b. formation of tiny papules. c. general distribution over the body. d. recurrence. e. loss of hair. ANS: A
Unlike other skin conditions, silvery papules and plaques characterize psoriasis. REF: p. 146 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 45. Painful vesicles are associated with a. psoriasis. b. pityriasis rosea. c. paronychia. d. herpes zoster. e. rosacea. ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area. Psoriasis and pityriasis may itch. Paronychia infection and rosacea may be tender to touch and do not produce vesicles. REF: p. 148 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 46. A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval
plaques over the trunk. They have fine scales and are arranged in a fernlike pattern with parallel alignment. What is the nurse’s next action? a. Teach infectious control measures. b. Inquire about another recent skin lesion. c. Inspect the palms and the soles. d. Inform the patient that this will resolve within 1 week. e. Ask about sexual contacts. ANS: B
The described rash is the typical presentation of pityriasis rosea. The rash is not infectious or contagious, does not involve the palms and soles, and usually lasts for several weeks. Pityriasis rosea begins with a sudden primary (herald) patch, with the generalized eruption to the trunk and extremities following 1 to 3 weeks later. REF: p. 146 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 47. Which of the following is an ABCD characteristic of malignant melanoma? a. Asymmetric borders b. Borders well demarcated c. Color of lesion is uniform
d. Diameter less than 6 mm e. Severe blistering or sunburns as a child ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as a child is a risk factor and not part of the ABCD characteristics. REF: p. 153 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 48. The most common cutaneous neoplasm is a. basal cell carcinoma. b. compound nevus. c. seborrheic keratosis. d. senile actinic keratosis. e. malignant melanoma. ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on sun-exposed parts of the body. REF: p. 152 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 49. Soft, painless, bluish papules in persons who are HIV-positive are most likely a. Kaposi sarcoma (KS). b. malignant melanoma. c. molluscum contagiosum. d. pityriasis rosea. e. herpes zoster. ANS: A
KS is the more common malignant skin lesion of HIV-infected persons. The lesions are soft, painless, bluish-purple macules or papules. REF: p. 153 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 50. A 5-year-old child presents with discrete vesicles on an erythemic base (dew drops on a rose
petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action? a. Ask about a family history of rashes. b. Inquire about other patterns of physical abuse. c. Inspect the buccal mucosa for Koplik spots. d. Inform the parent that this will resolve within a couple of days. e. Teach infectious control measures. ANS: E
The description of this child’s complaint is a varicella rash, not physical abuse or rubeola. Chickenpox is a highly communicable disease and can be prevented by immunization. The period of communicability lasts from 1 or 2 days before the onset of the rash until all the vesicles have crusted over, which usually takes about 1 week. REF: p. 161 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 51. During history taking, a mother states that her son awoke in the middle of the night
complaining of intense itching on his legs. Today your inspection reveals honey-colored exudate from the vesicular rash on his legs. Which condition is consistent with these findings? a. Exanthem b. Impetigo c. Solar keratoses d. Trichotillomania e. Drug eruption ANS: B
Impetigo causes intense pruritus, regional lymphadenopathy, and honey-colored exudative crusting as the vesicles or bullae rupture and dry. REF: p. 160 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 52. You are conducting a preschool examination on a 5-year-old child. Which injury would most
likely raise your suspicion that the child was being abused? a. Recent bruising over both knees b. A healed laceration under the chin c. A bruise on the right shin with associated abrasion of tissue d. Bruises in various stages of resolution over body soft tissues e. A scab on the elbow ANS: D
Toddlers and older children who bruise themselves accidentally are bruised over bony prominences, such as the knees, elbows, chin, and shin. Bruises over soft tissues are more consistent with abuse. REF: p. 163 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 53. Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older
adults indicates a. sexual abuse. b. physical neglect. c. psychologic abuse. d. violated rights. e. financial abuse. ANS: B
The question describes is the most common form of elder abuse—physical neglect. REF: p. 165
TOP: Discipline: Pathophysiology
MSC: Organ System: Skin/Connective
Chapter 09: Lymphatic System Test Bank—Medical MULTIPLE CHOICE 1. Which of the following organs does not have lymphatic vessels? a. Brain b. Kidneys c. Liver d. Lungs e. Appendix ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system). REF: p. 166 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 2. The predominant formed elements of normal lymph fluid are a. red blood cells. b. white blood cells. c. platelets. d. antigens. e. antibodies. ANS: B
Lymph fluid is mostly composed of a variety of lymphocytes, minimal red blood cells, no platelets, and some antigens and antibodies according to its immune function. REF: p. 167 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 3. Cells that line the lymph node sinuses perform the specific function of a. fat absorption. b. fetal immunization. c. hematopoiesis. d. platelet production. e. phagocytosis. ANS: E
Lymph nodes defend against the invasion of microorganisms by phagocytosis. REF: p. 166 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 4. Lymph ducts merge into the venous system at the a. portal vein. b. pulmonic vein. c. subclavian veins. d. vena cava.
e. jugular veins. ANS: C
The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins. REF: p. 167 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 5. Lymph flows faster in response to a. massage. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. e. decreased capillary pressure. ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage. REF: p. 167 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 6. An increased number of lymphocytes in the blood represents a systemic response to _____
infections. a. most bacterial b. most viral c. all parasitic d. HIV e. all fungal ANS: B
An increased number of lymphocytes in the blood represents a systemic response to most viral infections and to some bacterial infections. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 7. An organ that is essential to the development of protective immune function in infants but has
little or no demonstrated function in adults is the a. spleen. b. appendix. c. thymus. d. pancreas. e. liver. ANS: C
In adults, the thymus atrophies, and in older adults, it is replaced by fat and connective tissue. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
8. The examination of the upper left quadrant of the abdominal cavity is essential to the
evaluation of the immune system because of the location of which organ? a. Spleen b. Liver c. Thymus d. Pancreas e. Stomach ANS: A
The spleen is the largest of the lymphatic organs. It is located in the upper left portion of the abdomen. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 9. Enlarged tonsils and adenoids may obstruct the a. thoracic duct. b. esophagus. c. nasopharyngeal passageway. d. external auditory meatus. e. oral cavity. ANS: C
The palatine tonsils are located on either side of the pharynx, and the adenoids (pharyngeal tonsils) are found on the posterior wall of the pharynx, superior to the soft palate. If these structures become enlarged, they block the passage between the pharynx and the nasal cavity. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 10. When enlarged, which lymph nodes are most likely to be a sign of malignancy? a. Occipital b. Anterior cervical c. Posterior cervical d. Femoral e. Supraclavicular ANS: E
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma. REF: p. 171 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 11. Which lymphatic tissue is normally visible during the physical examination? a. Adenoids b. Peyer patches c. Palatine tonsils d. Thymus e. Submandibular ANS: C
The palatine tonsils are located at the back of the mouth on either side of the tongue and can be seen more readily than the adenoids. Submandibular nodes may be palpable but are not visible. Peyer patches are located in the small intestines, and the thymus is in the chest. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 12. Lymphoid tissue normally regresses to adult size by a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. e. the early 20s. ANS: D
The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 13. A congenital defect in the immune system of a 2-week-old infant may be suspected if a. there are small, palpable inguinal nodes. b. the umbilical cord has not yet dropped off. c. the tonsils are visible. d. the thymus is visible on a chest radiograph. e. the small postauricular nodes are palpable. ANS: B
In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 14. During pregnancy, the leukocyte count normally increases because of more a. reticulocytes. b. lymphocytes. c. atypical lymphocytes. d. polymorphonuclear leukocytes. e. monocytes. ANS: D
The type of leukocyte that increases during pregnancy is the polymorphonuclear leukocytes (neutrophils, eosinophils, and basophils), not the lymphocytes (including monocytes), reticulocytes, or atypical lymphocytes. REF: p. 171 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 15. As adults age, their ability to resist infection decreases because of lymphatic nodes becoming
more
a. b. c. d. e.
hematopoietic. mucoid. porous. profuse. fibrotic.
ANS: E
Older adults’ lymph nodes diminish in both number and size and are replaced with more fibrotic and fatty tissues. REF: p. 171 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 16. Which part of the hand is used to assess lymph node size? a. Pads of the fingers b. Tips of the fingers c. Palm d. Ulnar surface e. Dorsal surface ANS: A
The pads of the fingers are more sensitive and better for palpation than the fingertips and the palm; the ulnar surfaces of the hand and fingers are more sensitive for distinguishing vibration. The dorsal surface is more sensitive for distinguishing temperature. REF: p. 171 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 17. Which risk factor is least likely to result in contracting HIV? a. Prostitution b. Hemophilia c. Intravenous drug use d. Working with AIDS patients e. Sexual contact with intravenous drug users ANS: D
As a work-related risk for HIV infection, providing health care is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and intravenous drug use carry higher rates of transmission of HIV. REF: p. 172 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 18. Equipment for examining the lymphatic system includes a a. caliper. b. centimeter ruler. c. goniometer. d. syringe and needle. e. stethoscope. ANS: B
The centimeter ruler and the marking pencil are the only equipment needed for this system examination. They are used to measure and outline the borders of the nodes. REF: p. 172 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 19. Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender e. Matted ANS: D
Tenderness is almost always indicative of inflammation. REF: p. 173 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 20. Nodes located nearest the palatine tonsils are the a. supraclavicular. b. retropharyngeal. c. submental. d. submandibular. e. posterior cervical. ANS: B
The retropharyngeal (tonsillar) nodes and the parotid nodes lie at the angle of the mandible. The submental and submandibular nodes lie more distal to the mandible. The posterior cervical nodes lie posterior to the sternocleidomastoid muscles, and the supraclavicular nodes lie superior to the clavicles. REF: p. 174 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 21. Nodes that are palpable just inferior to the chin are the a. infraclavicular. b. Virchow. c. submandibular. d. parotid. e. submental. ANS: E
Nodes most inferior to the chin and distal from the mandible are the submental nodes. REF: p. 169 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 22. Nodes located nearest the elbow are the a. supraclavicular. b. axillary. c. epitrochlear.
d. popliteal. e. femoral. ANS: C
Nodes nearest the elbow are the epitrochlear, nearest the clavicle are the supraclavicular, nearest the knee are the popliteal, nearest the inguinal region are the femoral, and nearest the armpit are the axillary. REF: p. 173 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 23. Which landmark is the dividing line between the anterior and posterior cervical triangles? a. Clavicle b. Cervical spine c. Sternocleidomastoid d. Sternum e. Hyoid bone ANS: C
The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle. REF: p. 174 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 24. Which nodes are also called Virchow nodes? a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular e. Preauricular ANS: D
The supraclavicular nodes are also referred to as Virchow nodes. REF: p. 175 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 25. The harder and more discrete a node, the more likely a(n) a. innocent cause. b. infection. c. malignancy. d. metabolic disease. e. drug reaction. ANS: C
Tender nodes almost always indicate the presence of an infection, but a hard, discrete, and nontender node is more likely to represent a malignancy. REF: p. 173 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
26. Normal supraclavicular lymph nodes are a. clustered in a capsule. b. firm and discrete. c. less than 3 cm in diameter. d. not palpable. e. matted. ANS: D
Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable. REF: p. 171 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 27. Which of the following findings indicates that the examiner is assessing a blood vessel rather
than a lymph node? a. A bruit b. Size less than 1 cm c. Tenderness d. Redness e. Warmth ANS: A
Pulsations and auscultation of bruits indicate a blood vessel and not a lymph node. REF: p. 173 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 28. Transillumination is done during an examination of the lymphatic system to a. detect lymphatic pulsation. b. distinguish nodes from cysts. c. evaluate nodal contours. d. observe erythematous lesions. e. distinguish blood vessels from nodes. ANS: B
Larger nodal masses should be transilluminated to determine whether the mass is a cyst, rather than a node. REF: p. 173 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 29. Nodes located at the base of the skull are the _____ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear e. parotid ANS: C
The occipital nodes are at the base of the skull. REF: p. 174
TOP: Discipline: Immunology
MSC: Organ System: Hematopoietic/Lymphoid 30. Nodes located over the mastoid process are the _____ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear e. posterior cervical ANS: B
Nodes located superficially over the mastoid process are the postauricular nodes. REF: p. 174 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 31. When examining lymph nodes near a joint in the arm or leg, which of the following
maneuvers is likely to facilitate the examination? a. Extension of the extremity b. Circumduction of the extremity c. Abduction of the extremity d. Rotation of the extremity e. Flexion of the extremity ANS: E
Bending joint areas will ease taut tissues and allow for better accessibility to palpation. REF: p. 176 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 32. When examining the epitrochlear nodes, which joint should be supported? a. Elbow b. Knee c. Shoulder d. Wrist e. First metacarpophalangeal ANS: A
To palpate the epitrochlear nodes, you should support the elbow with one hand while you explore with the other hand. REF: p. 176 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 33. Palpation of the scalene triangle for supraclavicular nodes should be done with a. fingers hooked over the clavicle next to the sternocleidomastoid muscle. b. fingers along the depression above the medial humeral condyle. c. the pads of three fingers in a superficial circular motion. d. tissue rolled gently against the chest wall, moving sideways. e. the pads of the fingertips along the anterior surface of the trapezius muscle. ANS: A
Palpation of the supraclavicular lymph nodes is performed with the examiner’s hand gently flexing the patient’s head forward while the fingers of the opposite hand are hooked over the clavicle, lateral to the sternocleidomastoid muscle. REF: p. 175 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 34. To palpate the inguinal nodes, you should have the patient a. bend over a table and cough. b. lie supine, with the knees slightly flexed. c. lie supine, with the legs extended. d. stand with the back extended. e. lie prone, with the knees slightly flexed. ANS: B
To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed. REF: p. 176 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 35. It is not unusual to find postauricular and occipital nodes in a. children younger than 2 years of age. b. school-age children. c. adolescents. d. adults. e. older adults. ANS: A
Children younger than 2 years of age often have enlarged postauricular and occipital nodes. REF: p. 177 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 36. Large palatine tonsils are common in a. females. b. children. c. adolescents. d. young adults. e. older adults. ANS: B
The palatine tonsils are larger in early childhood and are not necessarily an indication of infection. REF: p. 170 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 37. Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be
associated with excessively enlarged a. branchial cleft cysts. b. cystic hygromas.
c. palatine tonsils. d. thyroglossal duct cysts. e. lymphangiomas. ANS: C
Palatine tonsil enlargement, grade 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck. REF: p. 177 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 38. The most important clue to the diagnosis of a child with an immunodeficiency disease is a. family history. b. illness in siblings. c. previous hospitalizations. d. serious recurring infections. e. cervical adenitis. ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon infections such as Pneumocystis jirovecii and other fungal infections that do not respond as expected to therapy. REF: p. 177 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 39. A red streak that follows the course of the lymphatic collecting duct is a finding associated
with a. Hodgkin lymphoma. b. lymphangitis. c. lymphedema. d. non-Hodgkin lymphoma. e. roseola infantum. ANS: B
Lymphangitis, inflammation of the lymphatic vessels, is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin lymphoma and non-Hodgkin lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. Roseola is a common early childhood viral illness that may present with occipital and postauricular adenopathy. REF: p. 178 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 40. To find the infection site associated with acute lymphangitis, the examiner should look _____
to the inflammation. a. proximal b. distal c. contralateral
d. anterior e. posterior ANS: B
The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak. REF: p. 178 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 41. The most common causes of acute suppurative lymphadenitis are a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex type 1 and type 2. d. streptococcal and staphylococcal organisms. e. mumps. ANS: D
Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis. REF: p. 178 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 42. Which disorder is characterized by a single node that is chronically enlarged and nontender in
a patient with no other symptoms? a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis e. Herpes simplex ANS: D
Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain. REF: p. 181 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 43. Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. e. discrete labial and gingival ulcers and high-grade fever. ANS: A
Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash. REF: p. 181
TOP: Discipline: Immunology
MSC: Organ System: Hematopoietic/Lymphoid 44. Enlarged inguinal nodes are likely to be associated with a. cat scratch disease. b. pelvic inflammatory disease. c. uterine cancer. d. testicular cancer. e. genital herpes. ANS: E
Uterine and testicular cancers are not inflammatory processes and are not likely to cause enlarged inguinal nodes. The female genitalia drain into the pelvis and the testes drain into the abdomen, where they are not accessible to inspection and palpation. Lesions to both the vulva and penile and scrotal areas cause inguinal nodal enlargement. Cat scratch disease usually involves the nodes of the head, neck, and axillae. REF: p. 176 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 45. Tender nodes associated with cat scratch disease are most commonly found in which area? a. Epitrochlear b. Popliteal c. Axilla d. Inguinal e. Supraclavicular ANS: C
Cat scratch disease results most commonly in nodal enlargement in the head, neck, and axillae. Although epitrochlear enlargement occurs most exclusively in cat scratch fever, its occurrence is less common. REF: p. 182 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 46. Which disorder is a dysfunction of cell-mediated immunity? a. Acute idiopathic polyneuritis b. Acquired immunodeficiency syndrome (AIDS) c. Epstein-Barr virus (EBV) mononucleosis d. Systemic lupus erythematosus (SLE) e. Toxoplasmosis ANS: B
HIV infection is characterized by a dysfunction of cell-mediated immunity (e.g., T lymphocytes). EBV is a viral infection, SLE is an autoimmune disorder, toxoplasmosis is a protozoan infection, and acute idiopathic polyneuritis (Guillain-Barré syndrome) is an immune disorder affecting the myelin sheaths. REF: p. 182 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid 47. Serum sickness is usually characterized first by the appearance of: a. diffuse lymph node enlargement.
b. c. d. e.
joint pain. urticaria. fever. a single enlarged posterior cervical node.
ANS: C
Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema. REF: p. 182 TOP: Discipline: Immunology MSC: Organ System: Hematopoietic/Lymphoid
Chapter 10: Head and Neck Test Bank—Medical MULTIPLE CHOICE 1. Which cranial nerves innervate the face? a. II and V b. III and VI c. V and VII d. VIII and IX e. I and VII ANS: C
Facial nerves are controlled by cranial nerves V and VII, cranial nerve I involves smell, cranial nerves II, III, and VI control the eyes, cranial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing. REF: p. 189
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
2. The parotid, submandibular, and sublingual salivary glands a. initiate protein digestion. b. inhibit dental caries. c. lubricate nasal surfaces. d. promote dry mouth. e. initiate fat digestion. ANS: B
These glands function together to secrete saliva, which moistens the mouth, aids in carbohydrate breakdown, and prevents cavities. REF: p. 185 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 3. The greatest degree of cervical mobility is at a. C1 to C2. b. C2 to C3. c. C3 to C4. d. C4 to C5. e. C6 to C7. ANS: D
C4 to C5 or C5 to C6 are the cervical vertebrae with the greatest movement. The type of movement includes flexion, extension, and hyperflexion, as well as horizontal movements of lateral flexion and rotation. REF: p. 185 TOP: Discipline: Neuroscience MSC: Organ System: Musculoskeletal 4. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the
_____ triangle. a. anterior
b. c. d. e.
posterior lateral medial ventral
ANS: B
Anatomically, these landmarks comprise what is referred to as the posterior triangle, which includes the posterior cervical lymph nodes. The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. REF: p. 185 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 5. The medial border of the sternocleidomastoid muscles and the mandible form the _____
triangle. a. dorsal b. posterior c. lateral d. medial e. anterior ANS: E
The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles, and clavicle form the posterior triangle. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. REF: p. 185 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 6. The largest endocrine gland in the body lies in the _____ triangle. a. anterior b. posterior c. lateral d. medial e. ventral ANS: A
The thyroid gland is the largest endocrine gland and lies in the anterior triangle. The posterior triangle does contain cervical lymph nodes, and the lateral and medial triangles are not anatomic landmarks. REF: p. 185 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 7. The ________ cartilage is shaped like a shield, with its notch on the upper edge marking the
level of bifurcation of the common carotid artery. a. cricoid b. hyoid c. thyroid
d. sternocleidomastoid e. external jugular ANS: C
The thyroid cartilage is shaped like a shield, with its notch on the upper edge marking the level of bifurcation of the common carotid artery. The hyoid bone sits just below the mandible, the thyroid gland is not a part of this region but rather lies across, and the sternocleidomastoid muscles are on the lateral side of the neck. The external jugular vein crosses the surface of the sternocleidomastoid muscle diagonally. REF: p. 185 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 8. Which structures disproportionately enlarge in males during adolescence? a. Coronal sutures b. Hyoid and cricoid cartilages c. Mandible and maxilla bones d. Nose and thyroid cartilages e. Mastoid processes and ears ANS: D
In adolescent males, the nose enlarges, and the thyroid cartilage becomes the largest component of the anterior larynx, known as the Adam’s apple. REF: p. 186
TOP: Discipline: Physiology
MSC: Organ System: General
9. Spaces between the cranial bones accommodate a. brain growth. b. cartilage formation. c. muscular expansion. d. nerve regeneration. e. cerebrospinal fluid. ANS: A
The suture lines, the spaces between the cranial bones, allow for brain growth and later fuse after the growth is complete. REF: p. 186 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 10. When examining the skull of a 4-month-old baby, you should normally find a. closure of the anterior fontanel. b. closure of the posterior fontanel. c. ossification of the all sutures. d. overlap of the cranial bones. e. closure of the sagittal and coronal sutures. ANS: B
At 2 months of age, the posterior fontanels should be closed or ossified with the anterior fontanels, a larger fontanel, closing at 24 months. The only time the cranial bones should overlap is during a vaginal birth as a result of pressure within the birth canal. Ossification of the sutures begins after completion of brain growth, at about 6 years of age, and is finished by adulthood. REF: p. 186 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 11. Closure of the anterior skull fontanel should occur by _____ months. a. 3 b. 6 c. 12 d. 18 e. 24 ANS: E
The anterior fontanels can remain palpable until 24 months, when they close. REF: p. 186 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 12. The thyroid gland is partially obscured by the a. cricoid cartilage. b. carotid artery. c. external jugular. d. sternocleidomastoid. e. hyoid bone. ANS: D
The thyroid sits just below the cricoid, an anatomic landmark for location of the thyroid; the lobes curve and are somewhat hidden by the sternocleidomastoid muscle. REF: p. 185 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 13. The brown or tan pigmentation on the forehead, nose, and malar prominence of some
pregnant women is called a. hormonal acne. b. erythema. c. alopecia. d. chloasma. e. craniotabes. ANS: D
Chloasma, brown or tan facial pigmentation during pregnancy, fades after delivery. Hormonal acne and erythema do not result in brown or tan pigmentation, and alopecia is loss of hair. Craniotabes is a softening of the outer table of the skull of an infant, often associated with rickets and hydrocephalus. REF: p. 197
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
14. Which of the following is an expected change in the assessment of the thyroid during
pregnancy? a. Palpation of the gland becomes difficult. b. A bruit may be auscultated. c. Inspection reveals a goiter. d. The gland is tender on palpation. e. The gland feels fibrotic. ANS: B
During pregnancy, the thyroid gland hypertrophies (not to the point of a goiter); palpation is easier; and because the gland also has increased vascularity, bruits are common. It is an abnormal finding for the thyroid to feel fibrotic, tender, or smaller. REF: p. 197
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
15. A bruit heard over the thyroid is suggestive of a. hypothyroidism. b. hyperthyroidism. c. thyroid cancer. d. thyroid cyst. e. thyroid nodule. ANS: B
Because of hypermetabolic states such as hyperthyroidism, a bruit may be heard as a result of the increased blood flow to the area. Auscultating a bruit is not symptomatic of hypothyroidism, cancer, or a cyst. A nodule is more indicative of cancer. REF: p. 197
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
16. Ms. G is a 22-year-old secretary who comes to the clinic with headaches of 6 weeks’ duration.
She tells the office assistant about her heavy schedule, including part-time work and evening classes. Her vital signs are normal. Which information is most appropriate to Ms. G’s history? a. Current medications b. Elimination patterns c. Immunization status d. Previous pregnancies e. Previous abdominal surgeries ANS: A
Some current medications, such as birth control pills, nitroglycerin, antihypertensives, antiseizure drugs, and some diabetic drugs, can be headache triggers. Withdrawal of headache medication can also trigger headaches. Elimination patterns, immunization status, and previous pregnancies or abdominal surgeries do not directly pertain initially to headaches. REF: p. 188
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
17. Observation during history taking is the best way to examine for a. head position. b. scalp lice. c. thyroid size. d. tracheal alignment.
e. thickening of the temporal arteries. ANS: A
Head positions and facial features are best observed when talking to the patient during the history. Scalp lice, thyroid size, thickening of the temporal arteries, and tracheal alignment are best assessed by palpation and closer physical observation. REF: p. 189
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
18. During a head and neck assessment of a neonate, it is important to screen for a. the presence of torticollis. b. signs and symptoms of cerebral palsy. c. uneven movement of the eyes. d. unilateral movement of the tongue. e. the absence of fine motor skills. ANS: A
Torticollis is a usual consequence caused by constraint of the newborn in utero and as a result of injury during vaginal delivery. The other symptoms may be difficult to discern because of the infant’s lack of fine motor skills and control of voluntary muscle groups. REF: p. 195 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 19. During physical examination of a 30-year-old Chinese man, you notice a slight asymmetry of
his face. The cranial nerve examination is normal. Your best action is to a. ask the patient if this characteristic runs in his family. b. perform monofilament testing on the face. c. obtain a complete blood analysis. d. record the finding in the patient’s chart. e. obtain a CT scan of the head. ANS: D
It is not abnormal to have some slight asymmetry of the face, which does not require further questioning, tests, or unnecessary laboratory work, but it does require a notation in the chart that could be referenced for future concerns. REF: p. 189
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
20. What is the significance of a patient with asymmetry of the entire side of the face? a. A degenerative process may be developing. b. A peripheral trigeminal nerve problem exists. c. Asymmetry of body sides is a normal finding. d. Visual and hearing problems will be present. e. Facial nerve paralysis may be present. ANS: E
When the entire side of the face is asymmetrical, facial nerve paralysis may be the cause. When asymmetry is concentrated only to the lower portion of the face, weakness of the nerves in this area may be present; if the mouth is asymmetric, there may be an existing trigeminal nerve dysfunction. Degenerative processes are more correlated with facial spasms. Visual and hearing problems may result in a patient turning his or her head to one side to favor the good eye or ear. REF: p. 189
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
21. A bruit, or blowing sound, over the skull or temporal region of an adult indicates a. degenerative change. b. hyperthyroid storm. c. a skull fracture. d. a vascular anomaly. e. Cushing syndrome. ANS: D
Temporal bruits can indicate a vascular anomaly such as arterial obstruction, an aneurysms, or a vascular neoplasm. Audible bruits are not associated with degenerative changes or skull fracture. Hyperthyroid storm would cause tachycardia and palpations but not usually a bruit. Patients with Cushing syndrome may have a rounded or moon-shaped face but no vascular bruit. REF: p. 192
TOP: Discipline: Pathophysiology
MSC: Organ System: General
22. Spasmodic muscular contractions of the head, face, or neck are called a. torticollis. b. tics. c. dimpling. d. webbing. e. chloasma. ANS: B
Tics, by definition, are spasmodic, repetitive contractions of the muscles of the face, head, or neck. The other conditions do not relate to muscle spasms. REF: p. 189
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
23. Coarse, dry, and brittle hair is associated with which metabolic disorder? a. Hypothyroidism b. Diabetes mellitus c. Addison disease d. Cushing syndrome e. Fetal alcohol syndrome ANS: A
Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes. REF: p. 192
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
24. An inconsequential finding on the head of an adult is a palpable a. embryonic remnant.
b. c. d. e.
posterior fontanel. sagittal suture ridge. skull indentation. nodule.
ANS: C
The sites of fusion on the skull are not generally palpable after 6 months of age; however, the sagittal suture line may be felt on some individuals. A skull indentation may indicate a skull fracture; the posterior fontanel should not be palpable after fusion. An embryonic remnant is associated with a branchial cleft cyst, not the head. Nodules should not be present and require further evaluation. REF: p. 192 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 25. Which is the best way to position a patient’s neck for palpation of the thyroid? a. Flexed away from the side being examined b. Flexed directly forward c. Flexed toward the side being examined d. Hyperextended directly backward e. Rotated away from the side being examined ANS: C
The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward and laterally toward the side being examined. REF: p. 194 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 26. A stethoscope is used in a head and neck examination to assess a. intracranial fluid. b. pulsating fontanels. c. skull bone development. d. thyroid vascular sounds. e. parotid glands. ANS: D
Although the skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits. REF: p. 194
TOP: Discipline: Gross Anatomy
27. Tracheal tug suggests the presence of a(n) a. enlarged thyroid. b. swallowing disorder. c. aortic aneurysm. d. thoracic carcinoma. e. hyperparathyroidism. ANS: C
MSC: Organ System: General
When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensation in sync with the pulse of the patient. An enlarged thyroid, swallowing disorder, hyperparathyroidism, or thoracic carcinoma would not produce a tracheal tug. REF: p. 193 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 28. The thyroid gland should a. be slightly left of midline. b. have a clear vascular sound. c. feel nodular. d. tug with each heartbeat. e. move when the patient swallows. ANS: E
It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate a nodular growth or enlargement. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a tug with each heartbeat is a sign of an aortic aneurysm. The consistency of the thyroid should be firm but pliable, not nodular. REF: p. 194
TOP: Discipline: Gross Anatomy
MSC: Organ System: Endocrine
29. You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The
right lobe is 25% larger than the left. These data indicate a. a congenital anomaly. b. a normal thyroid gland. c. a multinodular goiter. d. thyroiditis. e. a hypothyroid goiter. ANS: B
The situation described is most likely a normal finding; the right lobe of the thyroid gland is typically 25% larger than the left and measures 4 cm. The other choices produce enlargements beyond these normal findings. REF: p. 194
TOP: Discipline: Gross Anatomy
MSC: Organ System: Endocrine
30. The correct way to transilluminate an infant’s skull is to a. hold the light 18 inches from the skull. b. move the light toward and then away from the head. c. hold the light firmly against the ears. d. place the light firmly against the skull. e. shine the light inside the infant’s mouth. ANS: D
The technique for transillumination of an infant’s skull is to place the light source tightly against the skull so that no light escapes. The other choices will not produce transillumination. REF: p. 196 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 31. The most common form of birth trauma of the scalp is
a. b. c. d. e.
caput succedaneum. cephalhematoma. cranial bossing. torticollis. dilated scalp veins.
ANS: A
Caput succedaneum as a result of birth trauma, causes swelling of the scalp. The swelling can cross the suture lines. Cephalohematoma is a hematoma under the skull, and cranial bossing is compensatory growth of the skull related to craniosynostosis. Torticollis involves the neck. Dilated scalp veins and a head circumference increasing faster than expected may indicate increased intracranial pressure. REF: p. 195 TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective 32. Which of the following is true regarding caput succedaneum? a. It is a subperiosteal collection of blood. b. It is firm and its edges are well defined. c. It develops several days after delivery. d. It is seen over the presenting part of the head. e. It is a head circumference increasing faster than expected. ANS: D
Caput succedaneum is subcutaneous edema seen over the presenting part of the head during delivery as the skull passes through the pelvis; the scalp usually feels edematous to touch, which fades after a few days. REF: p. 195 TOP: Discipline: Gross Anatomy MSC: Organ System: Skin/Connective 33. Which of the following is true regarding cephalhematoma? a. It is bound by suture lines. b. The affected part feels soft. c. It is obvious at birth. d. The margins are poorly defined. e. It never feels fluctuant on palpation. ANS: A
The condition is subperiosteal, under the bone, and is contained by the margins of the suture lines; it does not cross the suture line. It is often unnoticed at birth and typically feels firm with its edges well defined. As it ages, it may liquefy and become fluctuant on palpation. REF: p. 195 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 34. Nuchal rigidity is most commonly associated with a. systemic lupus erythematosus. b. meningeal irritation. c. Down syndrome. d. cranial nerve V damage. e. thyroiditis.
ANS: B
Stiffness and an inability to flex the neck, or nuchal rigidity, is a classic symptom of meningeal irritation. Nuchal rigidity is not a symptom of systemic lupus erythematosus, Down syndrome, facial nerve damage, or thyroiditis. REF: p. 193
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
35. When noting a bulging fontanel with marked pulsations in a 6-month-old infant, you suspect a. normal development. b. Down syndrome. c. increased intracranial pressure. d. fever response to a viral infection. e. cephalhematoma. ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel feels slightly depressed with mild pulsations. REF: p. 196
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
36. Which type of headache occurs at night, is precipitated by alcohol consumption, and occurs
more often in men than in women? a. Classic migraine b. Temporal arteritis c. Muscular tension d. Hypertensive e. Cluster ANS: E
Cluster headaches are usually unilateral and occur at night; they are associated with alcohol consumption and have a higher prevalence in men. Classic migraine, temporal arteritis, muscular tension, and hypertensive headaches do not meet these criteria. REF: p. 198
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
37. A 29-year-old woman presents to the urgent care center with a history of a severe headache of
2 hours’ duration. She describes it as bandlike and constricting. In interviewing the woman about her complaint, you would ask a. whether she has experienced increased tearfulness. b. the date of her last menstrual period. c. whether these headaches started in childhood. d. whether she is particularly stressed or overworked. e. whether she is missing meals. ANS: D
This woman is describing tension headaches, which feel bandlike and similar to a clamping vice. These headaches are associated with stress, so you should inquire about her stress level. Increased tearfulness is common with cluster headaches, and migraines are associated with menstrual periods and missing meals. REF: p. 198
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
38. RJ presents with a freely movable cystic mass in the midline of the high neck region at the
base of the tongue. This is most likely a a. torticollis. b. branchial cleft cyst. c. Stensen duct stone. d. thyroglossal duct cyst. e. parotid gland tumor. ANS: D
A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. Torticollis is associated with the sternocleidomastoid muscle. A parotid gland tumor occurs around the ear and cheek bone area, a branchial cleft cyst occurs around the lateral neck area, and a Stensen duct stone occurs in the parotid duct. REF: p. 199
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
39. Moist skin with fine hair, prominent eyes, eyelid retraction, and a staring expression are
characteristics associated with a. Cushing syndrome. b. Graves disease. c. myxedema. d. systemic lupus erythematosus. e. Hippocratic facies. ANS: B
Skin problems along with changes in hair, protruding eyes, and a glazed look are symptoms associated with Graves disease or hyperthyroidism. Myxedema is a condition of hypothyroidism. Cushing syndrome is characterized by plump skin around the face, and lupus usually presents with a rash around the face. Hippocratic facies is usually seen in the terminal stages of illness; the skin is dry and rough. REF: p. 202
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
40. You are examining Ms. L, age 78 years. You find a sunken appearance of her eyes, cheeks,
and temporal areas. Her skin is dry, and her nose appears sharp. Ms. L’s facies description is associated with a. cutis laxa syndrome. b. Hurler syndrome. c. old age. d. terminal illness. e. myxedema. ANS: D
In the late stages of terminal illness, the face may appear sunken, the facial bones are more visible, and the skin is dry. This is referred to as Hippocratic facies. Hurler syndrome is marked by an enlarged skull and short neck. This is not a common finding in older adults. Cutis laxa is a rare condition in which the skin loses its elasticity and sags all over. Myxedema facies consists of dull, puffy, yellowed skin and periorbital edema as well as other characteristic findings.
REF: p. 189 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 41. Which of the following findings would be consistent with fetal alcohol syndrome? a. Corneal clouding b. Eye slanting c. Mild ptosis d. Symmetric bulging fontanels e. Maxillary hypoplasia ANS: C
With fetal alcohol syndrome (FAS), classic findings include a poorly formed or flat philtrum, widespread eyes with inner epicanthal folds and mild ptosis, a hirsute forehead, a short nose, a relatively thin upper lip, and small eye openings. Corneal clouding is seen with Hurler syndrome, eye slanting is seen in Down syndrome, and bulging fontanels are seen in hydrocephalus. Maxillary hypoplasia is seen with several congenital syndromes but not FAS. REF: p. 191
TOP: Discipline: Pathophysiology
MSC: Organ System: General
42. What abnormal palpable cystic mass in the neck rises from the foramen cecum at the junction
of the anterior two thirds and posterior third of the tongue? a. Branchial cleft cyst b. Thyroglossal duct cyst c. Lacrimal duct d. Submandibular lymph node e. Stensen duct ANS: A
Thyroglossal duct cyst is a remnant of fetal development which rises from the foramen cecum. Branchial cleft cyst is a remnant of fetal development which rises from incomplete involution of the branchial cleft. REF: p. 199
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
43. Which of the following is a chronic autoimmune disorder? a. Microcephaly b. Hashimoto disease c. Salivary gland tumor d. Down syndrome e. Hurler syndrome ANS: B
Hashimoto disease is a chronic autoimmune thyroid disease that occurs later in childhood and commonly affects women 30 to 50 years of age. The other choices are not autoimmune disorders. REF: p. 202
TOP: Discipline: Pathophysiology
MSC: Organ System: Endocrine
44. The premature union of cranial sutures that involves the shape of the head without mental
retardation is a. craniosynostosis. b. encephalocele.
c. microcephaly. d. myxedema. e. fetal alcohol syndrome. ANS: A
With craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but this does not involve mental retardation. Encephalocele, microcephaly, and fetal alcohol syndrome all involve mental retardation, and myxedema is a condition of hyperthyroidism. REF: p. 203 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
Chapter 11: Eyes Test Bank—Medical MULTIPLE CHOICE 1. A structure that protects the eye from foreign bodies is the a. conjunctiva. b. cornea. c. eyelid. d. sclera. e. lens. ANS: C
The eyelid distributes tears over the surface of the eye, limits the amount of light entering it, and protects the eye from foreign bodies. REF: p. 205
TOP: Discipline: Physiology
MSC: Organ System: Nervous
2. Tears flow over the cornea and drain via the lacrimal sac into the a. lacrimal gland. b. posterior pharynx. c. nasal meatus. d. thyroglossal duct. e. anterior fossa. ANS: C
Anatomically, the eye is closest to the nose, so tears drain from the lacrimal sac into the nasal lacrimal duct. The pharynx is the throat, and the thyroglossal duct deals with the tongue. The anterior fossa is the hollow bone that holds the lacrimal gland, which produces tears. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
3. Contraction of which eye structure controls the amount of light that reaches the retina? a. Retina b. Medial rectus muscle c. Sclera d. Lens e. Iris ANS: E
The iris is able to dilate and contract, allowing light to reach the retina. The retina is deep within the eye. The sclera is not able to dilate and contract, and the lens is merely a transparent disc that acts as a focus for the retina. REF: p. 206
TOP: Discipline: Physiology
4. Contraction or relaxation of the ciliary body a. allows voluntary blinking. b. changes lens thickness. c. regulates peripheral vision.
MSC: Organ System: Nervous
d. sends light impulses to the brain. e. regulates tear production. ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
5. The sensory network of the eye is the a. cornea. b. iris. c. pupil. d. retina. e. vitreous body. ANS: D
The retina acts as the sensory network of the eye in that it sends electric impulses to the brain transformed from light. The cornea, iris, and pupil act together as an opening for light to pass through the lens. The vitreous body is the gelatinous mass posterior to the lens that gives shape to the globe. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
6. Term infants have a visual acuity of about a. 20/20. b. 20/100. c. 20/200. d. 20/300. e. 20/400. ANS: E
Term infants are hyperopic, with a visual acuity of less than 20/400. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
7. At what age does an infant usually develop the ability to distinguish color? a. At birth b. 2 months c. 6 months d. 12 months e. 16 months ANS: C
By 6 months of age, vision has developed so that colors can be differentiated. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
8. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence
b. c. d. e.
Childhood Infancy Pregnancy Older adults
ANS: D
Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
9. A pregnant woman in her third trimester tells you that her vision has been a little blurred and
she thinks she needs to get new contact lenses. You should advise her to a. get new lenses as soon as possible to avoid complications. b. wait until several weeks after delivery to get new lenses. c. go to the nearest emergency department for evaluation. d. change her diet to include more yellow vegetables. e. decrease her water intake. ANS: B
Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur, but this subsides several weeks after pregnancy. This is a normal occurrence during pregnancy and is not diet- dependent, nor is it an emergency or urgent need. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
10. Which of the following is a relatively benign condition that may occur during pregnancy or
labor? a. Macular degeneration b. Papilledema c. Subconjunctival hemorrhage d. Cupping of the optic disc e. Presbyopia ANS: C
Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults. REF: p. 211
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
11. When does the lens usually become more rigid and the ciliary muscle of the iris become
weaker? a. Adolescence b. Around 25 years of age c. Around 35 years of age d. Around 45 years of age e. Older than 65 years of age ANS: D
Starting at around 45 years of age, the lens starts to change and become more rigid, and the ciliary muscles begin to weaken.
REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
12. A condition that typically develops by the age of 45 years is a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. e. cataracts. ANS: A
By 45 years of age, a condition known as presbyopia develops that involves a weakening of accommodation. Hyperopia occurs in early infancy; myopia and astigmatism can occur at any time. Cataracts generally develop in older adults. REF: p. 206
TOP: Discipline: Physiology
MSC: Organ System: Nervous
13. Which of the following findings, when seen in an infant, is most ominous? a. Difficulty tracking objects with the eyes b. Appearing to have better peripheral than central vision c. Blinking when bright light is directed at face d. White pupils on photographs e. The appearance of convergence ANS: D
The absence of a red reflex, either by physical examination or by white pupils with flash photography, is indicative of retinoblastoma, a serious retina tumor. The other choices are expected at this age. REF: p. 208
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
14. Which of the following is a genetic eye disorder that should be included in the history and
physical examination, under family history, for all members of the affected family? a. Constrictive iritis b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates ANS: B
Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders. REF: p. 208
TOP: Discipline: Pathophysiology
15. A Rosenbaum card is used to measure a. distance perception. b. near vision. c. peripheral distortion. d. the ability to identify colors.
MSC: Organ System: Nervous
e. extraocular movements. ANS: B
A Rosenbaum card is best used to measure nearsightedness because the patient holds the card a comfortable distance away and reads from the card. Distance perception cannot be accurately measured with a card held close. Peripheral vision and extraocular movements are assessed by an examiner by hand movements, and color identification can be measured with color cards. REF: p. 209
TOP: Discipline: Physiology
MSC: Organ System: Nervous
16. When measuring visual acuity, you are assessing cranial nerve a. I. b. II. c. IV. d. VI. e. VIII. ANS: B
Visual acuity is controlled by cranial nerve II. Cranial nerve I is designated for sense of smell, cranial nerve IV is designated for accommodation, and cranial nerve VI deals with lateral eye muscle movements. Cranial nerve VIII deals with hearing and balance. REF: p. 208
TOP: Discipline: Physiology
MSC: Organ System: Nervous
17. Measurement of near vision should be tested a. in each eye separately. b. with the head at a 45-degree angle. c. with the use of primary colors. d. using the Snellen chart. e. with the confrontation test. ANS: A
Near vision is measured by the Rosenbaum card and should be tested in each eye separately holding the card about 35 cm in front of the eye. Color identification is not measured by this test, and the Snellen chart tests visual acuity at 20 feet. The confrontation test is an imprecise way of testing peripheral vision. REF: p. 208
TOP: Discipline: Physiology
MSC: Organ System: Nervous
18. Mr. C’s visual acuity is 20/50. This means that he a. can see 50% of what the average person sees at 20 feet. b. has perfect vision when tested at 50 feet. c. can see 20% of the letters on the chart’s 20/50 line. d. can read letters while standing 20 feet from the chart that the average person could
read at 50 feet. e. is legally blind. ANS: D
Visual acuity is measured as a fraction in which the top number is the distance that the patient is standing from the chart and the bottom number is the distance that an average person can stand and still read the line. Vision not correctable to better than 20/200 is considered legal blindness. REF: p. 209
TOP: Discipline: Physiology
MSC: Organ System: Nervous
19. Peripheral vision can be estimated by means of which test? a. Confrontation b. Pupillary reaction c. Accommodation d. Snellen E chart e. Swinging flashlight ANS: A
The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done by observing the pupil’s response to light. The accommodation test deals with pupil reaction to light, and the Snellen chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect. REF: p. 209
TOP: Discipline: Physiology
MSC: Organ System: Nervous
20. The criterion for adequacy of a patient’s visual field is a. the ability to discriminate primary colors. b. the ability to discriminate details. c. correspondence with the visual field of the examiner. d. distance vision equal to that of an average person. e. pupillary constriction when an object is moved close to the nose. ANS: C
The examiner continuously compares his or her own peripheral vision with that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match. The confrontation test does not assess colors, details, or distance vision. Having a patient look at a distant object and then one held 10 cm from the nose tests the pupillary response to accommodation. REF: p. 209
TOP: Discipline: Physiology
21. Periorbital edema is a. an abnormal sign. b. expected with aging. c. more common in males. d. present in children. e. an abnormality of lipid metabolism. ANS: A
MSC: Organ System: Nervous
A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: General
22. Xanthelasma may suggest that the patient has an abnormality of a. lipid metabolism. b. cognitive function. c. renal metabolism. d. bone marrow function. e. thyroid disease. ANS: A
Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristic of a lipid metabolism problem. The other conditions are not associated with eye plaques. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: General
23. Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her
eyes, you note that the left upper eyelid droops, covering more of the iris than does the right. This is recorded as _____ on the _____. a. exophthalmos; left b. ptosis; left c. nystagmus; left d. astigmatism; right e. ectropion; left ANS: B
Ptosis is when one of the upper eyelids covers more of the iris than the other eyelid, possibly extending over the pupil. Exophthalmos, nystagmus, and astigmatism are not conditions of the eyelid. Ectropion is an eversion of the lower eyelid. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
24. Ptosis may be secondary to a. blepharitis. b. hyperthyroidism. c. psoriasis. d. paresis of a branch of cranial nerve III. e. entropion. ANS: D
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
25. What is the condition called when the eyelid is turned away, or everted, from the globe? a. Ectropion b. Entropion
c. Exophthalmos d. Ptosis e. Acute hordeolum ANS: A
Ectropion describes an everted lower eyelid that is turned away from the eye. Entropion describes the lower eyelid turning inward. Ptosis refers to a drooping of the upper eyelid. Exophthalmos is when the eye globe bulges. Acute hordeolum is an inflammation of the follicle of an eyelash. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
26. Entropion implies that the eyelid is a. drooping. b. everted. c. edematous. d. turned inward. e. inflamed. ANS: D
Entropion of the lower eyelid does not imply drooping, eversion, inflammation, or edema but is a slight inward turn of the lower eyelid. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
27. A condition in which the eyelids do not completely meet to cover the globe is called a. glaucoma. b. lagophthalmos. c. exophthalmos. d. hordeolum. e. blepharitis. ANS: B
Lagophthalmos is a term used to describe the condition in which the eyelids do not completely meet when closing. Glaucoma involves the optic nerve, exophthalmos involves bulging eyes, and hordeolum is better known as a sty. Blepharitis is crusting along the eyelashes, which can have several causes. REF: p. 210
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
28. Inspection of the tarsal conjunctiva should be performed a. with every eye examination. b. in eye examinations in patients older than 45 years of age. c. when a foreign body may be present. d. for the patient with glaucoma. e. with the patient looking upward. ANS: C
Inspecting the tarsal conjunctiva involves asking the patient to look down and pull the top eyelid down and up while everting the eyelid. This maneuver is reserved for inspection of a foreign body, as indicated.
REF: p. 211
TOP: Discipline: Physiology
MSC: Organ System: General
29. An allergy can cause the conjunctiva to have a a. cobblestone pattern. b. dry surface. c. subconjunctival hemorrhage. d. rust-colored pigment. e. pale appearance. ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment. REF: p. 211
TOP: Discipline: Pathophysiology
MSC: Organ System: General
30. An abnormal growth of conjunctiva extending over the cornea from the limbus is known as a. a cataract. b. erythematous. c. glaucoma. d. conjunctivitis. e. a pterygium. ANS: E
An abnormal growth of the conjunctiva that extends over the cornea is called a pterygium. Cataracts and glaucoma do not affect the conjunctiva, and erythematous means that the area is red and irritated. Conjunctivitis is an inflammation of the conjunctiva. REF: p. 212
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
31. A pterygium is more common in people heavily exposed to a. high altitudes. b. tuberculosis. c. ultraviolet light. d. cigarette smoke. e. lead. ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva. REF: p. 212
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
32. Mr. B was admitted from the emergency department, and you are completing his physical
examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been a. in a coma. b. taking sympathomimetic drugs (e.g., cocaine). c. taking opioid drugs (e.g., morphine). d. treated for head trauma.
e. atropine overdosed. ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or drops for glaucoma. Pupils are usually dilated greater than 6 mm in a coma and with sympathomimetic drugs, atropine, and head trauma. REF: p. 213
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
33. When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient
to respond by a. blinking. b. copious tearing. c. pupil dilation. d. reflex smiling. e. pupil constriction. ANS: A
Blinking is an expected response to corneal sensitivity testing, which involves gently touching the cornea with a piece of cotton. Copious tearing, pupil dilation, constriction, and reflex smiling do not involve cranial nerve V. REF: p. 212
TOP: Discipline: Physiology
MSC: Organ System: Nervous
34. You observe a pupillary response as the patient looks at a distant object and then at an object
held 10 cm from the bridge of the nose. You are assessing for a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. e. corneal circus senilis. ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation. REF: p. 213
TOP: Discipline: Physiology
MSC: Organ System: Nervous
35. Mydriasis accompanies a. coma. b. diabetes. c. hyperopia. d. astigmatism. e. morphine administration. ANS: A
Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. Opiates cause miosis.
REF: p. 213
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
36. An inequality of pupillary size is called a. hyperopia. b. diopter. c. ptosis. d. anisocoria. e. mydriasis. ANS: D
Anisocoria is when the pupil sizes are not the same when compared together but the reflexes remain normal. Hyperopia is visual acuity equal to or worse than 20/400 in infants. Mydriasis is when the pupil sizes are large and even. Ptosis is droopy eyelid, and diopter is a unit of measurement used to focus a lens. REF: p. 213
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
37. When inspecting the region of the lacrimal gland, palpate a. the lower orbital rim near the inner canthus. b. in the area between the arch of the eyebrow and the upper eyelid. c. beneath the lower eyelid adjacent to the inner canthus. d. adjacent to the lateral aspect of the eye, just beneath the upper eyelid. e. medially above the eyebrow. ANS: A
The lacrimal gland is located in the area between the arch of the eyebrow and the upper lid. The lacrimal sac is located in the corner of the eye closest to the nose near the inner canthus. REF: p. 214
TOP: Discipline: Physiology
MSC: Organ System: General
38. You note a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle in
an 80-year-old woman. Which action is appropriate? a. Record the finding in the patient’s record. b. Refer the patient to an ophthalmologist. c. Attribute the finding to type II hyperlipidemia. d. Ask the patient if she remembers being hit in the eye. e. Test the patient immediately for liver disease. ANS: A
This finding is consistent with senile hyaline plaque and does not indicate an emergency or disease process, but should be charted as a finding. With hyperlipidemia, yellow plaques are seen. Liver disease may produce a diffuse, yellow-green pigment in the sclera. REF: p. 214
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
39. An examination to assess for extraocular muscle imbalance is conducted by a. comparing pupillary responses to different shapes. b. everting the upper and lower eyelids. c. inspecting slightly closed lids for fasciculations. d. transilluminating the cornea with tangential light. e. having the patient follow your finger through different planes.
ANS: E
The test for extraocular muscle function is to have the patient follow an object as you move it through the planes of vision while observing for nystagmus. REF: p. 215
TOP: Discipline: Physiology
MSC: Organ System: Nervous
40. When there is an imbalance found with the corneal light test, you should then perform the
_____ test. a. confrontation b. accommodation c. cover–uncover d. visual acuity e. pupillary light reflex ANS: C
If the corneal light reflex demonstrates an imbalance, the next test to perform is the cover– uncover test. The confrontation test measures peripheral vision, the pupillary light reflex, the accommodation test assesses pupillary reaction to light, and the visual acuity test measures vision, all of which will not help to assess eye muscle imbalance further. REF: p. 215
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
41. To see retinal details in a patient with myopia, the examiner will need to a. adjust the ophthalmoscope into the plus lenses. b. move the ophthalmoscope backward. c. move the hand farther forward. d. examine the patient in a well-lighted room. e. turn the ophthalmoscope to a minus lens. ANS: E
A patient with myopia (nearsighted) has longer eyeballs, so light rays focus in front of the retina. To see the retina, the examiner should use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used. REF: p. 217
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
42. The unit of measurement in describing lesion size and location on the fundus is the a. disc diameter. b. macular diameter. c. pupillary diameter. d. centimeter. e. diopter. ANS: A
When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measurement used to describe lesion size and location on the fundus. REF: p. 217
TOP: Discipline: Physiology
MSC: Organ System: Nervous
43. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to
examine the a. retina. b. lens. c. retinal vessels. d. macula. e. optic disc. ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light. REF: p. 218
TOP: Discipline: Physiology
MSC: Organ System: Nervous
44. After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate
the optic disc. You should a. follow the vessel as it branches out. b. have the patient move his or her eye laterally. c. have the patient move his or her eye up. d. have the patient move his or her eye down. e. follow the vessel as it converges into larger vessels. ANS: E
When you locate a vessel, follow it in the direction of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching. REF: p. 217
TOP: Discipline: Physiology
MSC: Organ System: Nervous
45. After completion of your ophthalmoscopic examination, you record that the arteriole-to-
venule ratio is 1:2 This indicates that the a. arterioles are narrowed. b. venules are narrowed. c. ratio is normal for a child. d. ratio is normal for an adult. e. arterioles are dilated. ANS: A
The expected ratio of arterioles to venules is 3:5 to 2:3. A 1:2 ratio indicates that the arterioles are narrower than normal. REF: p. 217
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
46. If a patient has early papilledema, the examiner will be able to detect a. dilated retinal veins. b. retinal vein pulsations. c. sharply defined optic discs. d. visual defects. e. narrowed retinal veins. ANS: A
Papilledema is cause by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. On examination, papilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope. REF: p. 219
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
47. Cupping of the optic disc may be a result of a. migraine headaches. b. diabetes. c. glaucoma. d. dehydration. e. cataracts. ANS: C
Cupping is seen with causes of increased intraocular pressure such as glaucoma. Migraine headaches and dehydration do not cause cupping of the optic disc. Diabetes results in cottonwool patches and hemorrhages. Cataracts are clouding of the lens. REF: p. 219
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
48. Drusen bodies are most commonly a consequence of a. glaucoma. b. aging. c. presbyopia. d. papilledema. e. hypertension. ANS: B
Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy. REF: p. 218
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
49. When drusen bodies are noted to be increasing in number or in intensity of color, the patient
should be further evaluated with a(n) a. Amsler grid. b. Snellen E chart. c. litmus test. d. confrontation test. e. Keith-Wagner-Barker (KWB) system. ANS: A
Drusen bodies, when they increase in number or intensity of color, may indicate a precursor state of macular degeneration. When this happens, the patient’s central vision should be assessed using the Amsler grid. The Snellen chart measures visual acuity, the litmus test is used for determining testing pH, and the confrontation test examines peripheral vision. The KWB system is a way of classifying retinal changes associated with hypertension. REF: p. 218
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
50. Cotton wool spots are most closely associated with a. glaucoma. b. normal aging processes. c. hypertension. d. eye trauma. e. hyperthyroidism. ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes. Hyperthyroidism, glaucoma, and eye trauma do not present with cotton wool spots. REF: p. 219
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
51. The Keith-Wagner-Barker system group IV is characterized by the development of a. an increased light reflex in the arterioles. b. crossing defects. c. cotton wool spots. d. papilledema. e. retinal hemorrhages. ANS: D
The Keith-Wagner-Barker system is used to classify changes to the eyes caused by hypertension. Group IV is the class that represents evidence of papilledema. Increased light reflex is in group I, crossing defects are in group II, and cotton wool spots and retinal hemorrhages are in group III. REF: p. 220
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
52. Which of the following may be suggestive of Down syndrome? a. Drusen bodies b. Papilledema c. Narrow palpebral fissures d. Prominent epicanthal folds e. Entropion ANS: D
Prominent epicanthal folds, or slanting of the eyes, may be normal in Asian infants, but in other ethnic groups, it may indicate Down syndrome. Drusen bodies, papilledema, entropion, and narrow palpebral fissures are not associated with Down syndrome. REF: p. 220
TOP: Discipline: Genetics
MSC: Organ System: Nervous
53. To differentiate between infants who have strabismus and those who have pseudostrabismus,
use the a. confrontation test. b. corneal light reflex. c. E chart. d. Amsler grid. e. cover–uncover test. ANS: B
The corneal light reflex is used with infants to differentiate between strabismus and pseudostrabismus by noting an asymmetric versus symmetric light reflex. The confrontation test, Amsler grid, cover–uncover test, and “E” chart do not assess strabismus. REF: p. 221
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
54. You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would
first a. dim the room lights. b. elicit pain. c. place the newborn in the supine position. d. shine the penlight in the newborn’s eyes. e. apply mydriatics. ANS: A
The best way to assess the eyes of a newborn is to start by dimming the lights because it encourages infants to open their eyes. REF: p. 218
TOP: Discipline: Physiology
MSC: Organ System: General
55. White specks scattered in a linear pattern around the entire circumference of the iris are called a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy. ANS: D
Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation. REF: p. 221
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
56. Opacities of the red reflex may indicate the presence of a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. e. diabetes. ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in newborns. Opacities or dark spots of the red reflex are not associated with hypertension, diabetes, hydrocephalus, or myopia. REF: p. 221
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
57. The Snellen E chart is appropriate for initial visual acuity in a child of which age? a. Newborn b. 6 months c. 18 months
d. 3 years e. 8 years ANS: D
For the Snellen chart to be accurate, the child must be cooperative, and usually by age 3 years, visual acuity can be assessed. Newborns and infants 6 and 18 months of age are much too young to assess visual acuity, and age 8 years is too late to test for it initially. REF: p. 221
TOP: Discipline: Physiology
MSC: Organ System: Nervous
58. You normally expect a child to achieve 20/20 vision by age ____ years. a. 3 b. 4 c. 5 d. 6 e. 8 ANS: A
At 3 years of age, children are expected to achieve 20/20 visual acuity. REF: p. 207
TOP: Discipline: Physiology
MSC: Organ System: Nervous
59. What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic
agents when examining a pregnant woman if the examination is mandatory? a. Have the woman keep her eyes closed for several minutes. b. Instill half the usual dosage. c. Keep the patient supine. d. Use nasolacrimal occlusion after instillation. e. Have the patient keep her head turned and flexed. ANS: D
To reduce absorption systemically, the examiner may use the nasolacrimal occlusion after application, which involves pinching the upper bridge of the nose. Keeping the eyes closed, instilling half of the usual dosage, and having the patient position her head a certain way will not prevent absorption through the nasal membranes. REF: p. 222
TOP: Discipline: Physiology
MSC: Organ System: Nervous
60. Episcleritis may indicate a. lipid abnormalities. b. an autoimmune disorder. c. an anaphylactoid reaction. d. severe anemia. e. thyroid disease. ANS: B
Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with autoimmune disorder. Lipid abnormalities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms. REF: p. 223
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
61. The most common cause of exophthalmos is a. Graves disease. b. diabetes. c. hypertension. d. glaucoma. e. Crohn disease. ANS: A
Graves disease is the most common cause of exophthalmos, which is an increase in the eye tissue resulting in the characteristic bulging eyes. However, if exophthalmos only involves one eye, suspect a tumor as the cause. Diabetes, hypertension, glaucoma, and Crohn disease do not cause eye tissue to increase in size. REF: p. 223
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
62. Horner syndrome is manifested by a. proptosis and contralateral mydriasis. b. excessive watering of the eyes. c. blurring of vision when glucose levels fall. d. ipsilateral miosis and mild ptosis. e. band keratopathy and miosis. ANS: D
Horner syndrome is characterized by mild pupil constriction and drooping of the upper eyelid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis involves enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. Band keratopathy is a result of chronic corneal disease and is not associated with Horner syndrome. REF: p. 225
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
63. Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most
commonly seen in a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa. ANS: B
Dot hemorrhages or tiny aneurysms are characteristic of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, lupus, glaucoma, or retinitis pigmentosa. REF: p. 225
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
64. Changes seen in proliferative diabetic retinopathy are the result of a. anoxic stimulation. b. macular damage. c. papilledema. d. minute hemorrhages.
e. chorioretinal scarring. ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply because of failing capillaries causes new vessel growth. Macular damage, papilledema, chorioretinal inflammation, and resultant scarring do not involve new inadequate vessel growth. REF: p. 226
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
65. Bone spicule pigmentation is a hallmark of a. chorioretinal pigmentosa. b. cytomegalovirus infection. c. lipemia retinalis. d. retinitis pigmentosa. e. choroidal nevus. ANS: D
Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules. REF: p. 227
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
66. An initial sign of retinoblastoma in an infant is a. the cat’s eye reflex. b. the red reflex. c. the corneal light reflex. d. the absence of a blink reflex. e. Brushfield spots. ANS: A
Retinoblastoma in an infant is marked by a characteristic white reflex, also called cat’s eye reflex. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma. Brushfield spots on the iris strongly suggest Down syndrome or mental retardation. REF: p. 228
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
67. Retinal hemorrhages in an infant require investigation for a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor. d. child abuse. e. strabismus. ANS: D
Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages. REF: p. 229
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
Chapter 12: Ears, Nose, and Throat Test Bank—Medical MULTIPLE CHOICE 1. In adults, the length of the external auditory canal is _____ cm. a. 0.5 b. 1 c. 2.5 d. 4 e. 5 ANS: C
The external ear canal is approximately 2.5 cm long in adults. REF: p. 231
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
2. The middle ear contains the a. cerumen and sebaceous glands. b. umbo and malleus. c. vestibule and cochlea. d. pars tensa and semicircular canals. e. helix and antihelix. ANS: B
The middle ear contains the ossicles, which are three small bones: the malleus (the umbo is part of the malleus), the incus, and the stapes. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Cerumen and sebaceous glands lie outside the middle ear; the semicircular canals, vestibule, and cochlea lie in the inner ear. The helix and antihelix are parts of the auricle. REF: p. 231
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
3. The middle ear is normally filled with a. mucous collections. b. blood. c. serous fluid. d. cerebrospinal fluid. e. air. ANS: E
The middle ear normally is an air-filled cavity in the temporal bone. REF: p. 231
TOP: Discipline: Physiology
4. The hair cells of Corti and membrane of Corti a. maintain equilibrium. b. protect the ear from foreign particles. c. stimulate the eighth cranial nerve. d. transmit vibrations to the ossicles.
MSC: Organ System: General
e. produce a waxy lubricant. ANS: C
Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve. REF: p. 231
TOP: Discipline: Physiology
MSC: Organ System: Nervous
5. The organ of Corti is a coiled structure located inside the a. cochlea in the inner ear. b. pars flaccida in the tympanic membrane. c. eustachian tube. d. lateral aspect of the pinna. e. tragus. ANS: A
The cochlea is a coiled structure within the inner ear that contains the organ of Corti. REF: p. 231
TOP: Discipline: Physiology
MSC: Organ System: Nervous
6. Which ear structure is responsible for equalizing atmospheric pressure when swallowing,
sneezing, and yawning? a. Eustachian tube b. Inner ear c. Semicircular canals d. Triangular fossa e. Oval window ANS: A
The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and the middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing. REF: p. 231
TOP: Discipline: Physiology
MSC: Organ System: General
7. The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the
_____ sinuses. a. ethmoid b. frontal c. maxillary d. cribriform e. sphenoid ANS: C
The maxillary sinuses lie along the nasal cavity near the cheek, the ethmoid sinuses lie behind the frontal sinuses near the superior portion of the nasal cavity, and the paranasal sinuses are extensions of the nasal cavities within the skull. REF: p. 233
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
8. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus
tenderness, you should palpate over the a. sphenoid and frontal sinuses. b. maxillary and frontal sinuses. c. maxillary sinuses only. d. sphenoid sinuses only. e. ethmoid and frontal sinuses. ANS: C
Only the maxillary and the frontal sinuses are accessible for physical examination; however, the young child does not develop frontal sinuses until 7 to 8 years of age. REF: p. 236
TOP: Discipline: Physiology
MSC: Organ System: General
9. A 30-year-old woman presents with rapid swelling beneath her jaw that suddenly appears
while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate a. bilaterally along the buccal mucosa. b. under the tongue, along each side of the frenulum. c. dorsum of the tongue. d. beside the gingivae near each molar. e. along the roof of the mouth. ANS: B
The vast majority of these stones occur in the Wharton duct from the submaxillary gland, which can be palpated along each side of the frenulum under the tongue. REF: p. 247 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 10. An infant’s auditory canal, when compared with an adult’s, is a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved forward. d. short and curved downward. e. long, wide, and straight. ANS: B
Compared with an adult’s, the infant’s auditory canal is shorter and has an upward curve, which is why pulling the pinna down straightens the canal. REF: p. 236
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
11. When examining an infant’s middle ear, the practitioner should use one hand to stabilize the
otoscope against the head while using the other hand to a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. e. pull the auricle up. ANS: A
You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal. REF: p. 249
TOP: Discipline: Physiology
MSC: Organ System: General
12. The eruption of permanent teeth most commonly begins with the a. upper central incisors. b. upper canines. c. lower central incisors. d. lower canines. e. upper lateral incisors. ANS: C
The central incisor on the lower jaw usually erupts between 6 and 7 years of age as the first permanent teeth, the lower canines appear at 9 to 10 years of age, the upper central incisors at 7 to 8 years of age, and the upper canines at 11 to 12 years of age. The upper lateral incisors appear at 8 to 10 years of age. REF: p. 235 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 13. The pregnant woman can expect to experience a. more nasal stuffiness. b. a sensitive sense of smell. c. drooling. d. enhanced hearing. e. decreased vascularity of the gums. ANS: A
Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. Increased vascularity and proliferation of connective tissue of the gums also may occur. REF: p. 236
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
14. During what developmental stage are hoarseness, voice cracking, and a persistent cough a
common finding? a. Adolescence b. Infancy c. Menopause d. Pregnancy e. Childhood ANS: D
Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and persistent cough. REF: p. 236
TOP: Discipline: Physiology
MSC: Organ System: General
15. Which of the following is associated with age-related hearing loss? a. Degeneration of the hair cells of the organ of Corti b. Excess resorption of bone cells of the ossicle chain
c. Increased pliability of the tympanic membrane d. More serous cerumen e. Proliferation of the stria vascularis ANS: A
Nearly one third of adults older than 65 years have hearing loss. Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea. REF: p. 236
TOP: Discipline: Physiology
MSC: Organ System: Nervous
16. You are performing hearing screening tests. Difficulty in hearing the highest frequencies
would be expected in a ___-year-old patient. a. 7 b. 12 c. 20 d. 40 e. 65 ANS: E
Nearly one third of adults 65 years of age and older have sensorineural hearing loss. REF: p. 236
TOP: Discipline: Physiology
MSC: Organ System: Nervous
17. Mr. S presents with the complaint of hearing loss. You specifically inquire about current
medications. Which medications, if listed, are likely to contribute to his hearing loss? a. Chlorothiazide b. Acetaminophen c. Salicylates d. Cephalosporins e. Penicillins ANS: C
Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. Chlorothiazide diuretics, acetaminophen, penicillins, and cephalosporins are considered non-ototoxic. REF: p. 236 TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Nervous 18. Mr. W, age 25 years, has recovered recently from an upper and lower respiratory infection. He
describes long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history? a. Age-specific data b. Past medical data c. Family history d. Social history e. Personal history ANS: B
This information is part of the past medical history. REF: p. 238
TOP: Discipline: Physiology
MSC: Organ System: General
19. A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later a. hearing loss. b. lichen planus. c. tooth decay. d. meningitis. e. sinusitis. ANS: A
Risk factors for hearing loss in infants include infection, irradiation, drug abuse, and syphilis in the mother, as well as birth weight less than 1500 g, excessively high bilirubin level, infections (e.g., bacterial meningitis recurrent otitis media), cleft palate, craniofacial abnormalities, ototoxic antibiotic use, head trauma, and hypoxic episodes in infancy. REF: p. 238
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
20. To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz e. Greater than 2000 Hz ANS: C
Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. REF: p. 238
TOP: Discipline: Physiology
MSC: Organ System: Nervous
21. You are using a pneumonic attachment on the otoscope while assessing tympanic membrane
movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to a. remove all cerumen from the canal. b. make sure the speculum is sealed form outside air. c. squeeze the bulb with more force. d. insert the speculum to depth of 2 cm. e. use a smaller plastic speculum. ANS: B
When using the pneumatic attachment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb. REF: p. 240
TOP: Discipline: Physiology
MSC: Organ System: General
22. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or a. digestive disorder. b. skeletal anomaly. c. renal disorder. d. Ménière disease.
e. heart defect. ANS: C
An auricle with a low-set or unusual angle may indicate chromosomal aberrations or renal disorders. REF: p. 249
TOP: Discipline: Pathophysiology
MSC: Organ System: General
23. When conducting an adult otoscopic examination, you should a. position the patient’s head leaning toward you. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. e. pull the auricle down and forward. ANS: C
Select the largest speculum that will comfortably fit in the patient’s ear. The handle should be held between the thumb and the index finger, supported on the middle finger. The patient’s head should be positioned toward the opposite shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut. REF: p. 240
TOP: Discipline: Physiology
MSC: Organ System: General
24. Normal tympanic membrane color is a. amber. b. chalky white. c. greenish. d. pearly gray. e. red. ANS: D
The expected normal finding for tympanic color is pearly gray. REF: p. 240
TOP: Discipline: Gross Anatomy
MSC: Organ System: General
25. Bulging of an amber tympanic membrane without mobility is most often associated with a. a middle ear effusion. b. a healed tympanic membrane perforation. c. impacted cerumen in the canal. d. repeated and prolonged crying cycles. e. a Pseudomonas infection of the auditory canal. ANS: A
An amber color, with bulging of the tympanic membrane and without mobility or redness, most often indicates the presence of fluid in the middle ear. REF: p. 241
TOP: Discipline: Pathophysiology
MSC: Organ System: General
26. In the presence of otitis externa, tympanic membrane perforation, or a myringotomy tube, you
should a. avoid performing otoscopic examinations.
b. c. d. e.
clean the inner ear with soap. instill alcohol into the ear. never use a cerumen spoon. avoid instilling fluids.
ANS: E
Any ear irrigation should be avoided in the presence of otitis externa, perforated tympanic membrane, myringotomy tube, or mastoid cavity. These are not contraindications for otoscopic examinations or clearing the outer canal of cerumen; only the auricle can be cleaned with soap. REF: p. 240
TOP: Discipline: Physiology
MSC: Organ System: General
27. When hearing is evaluated, which cranial nerve is being tested? a. III b. IV c. VIII d. IX e. XII ANS: C
The eighth cranial nerve (CN VIII), the vestibulocochlear nerve, is associated with hearing. REF: p. 231
TOP: Discipline: Physiology
MSC: Organ System: Nervous
28. Speech with a monotonous tone and erratic volume may indicate a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. e. dry cerumen. ANS: B
Speech with a monotonous tone and erratic volume may indicate hearing loss. Although hearing may be affected in the other choices, they do not result in hearing loss. REF: p. 241
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
29. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test
for a. b. c. d. e.
air conduction of sound. bone versus air conduction. otitis externa. otitis media. lateralization of sound.
ANS: E
Placing the fork on the midline vertex of the patient’s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. REF: p. 242
TOP: Discipline: Physiology
MSC: Organ System: Nervous
30. To perform the Rinne test, place the tuning fork on the a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. e. occiput. ANS: B
The fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. REF: p. 241
TOP: Discipline: Physiology
MSC: Organ System: Nervous
31. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized
to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen. e. serous otitis. ANS: A
These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa, impacted cerumen, and serous otitis are conditions that can cause conductive hearing problems. REF: p. 242
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
32. Nasal symptoms that imply an allergic response include a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal membranes. d. a firm consistency of the turbinates. e. a deviated septum. ANS: B
An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and the bone of the nose. REF: p. 243 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 33. When you ask the patient to identify smells, you are assessing which cranial nerve? a. I b. II c. III d. IV e. VIII ANS: A
The first cranial nerve (CN I), the olfactory nerve, is tested when you ask a patient to identify different smells. REF: p. 244
TOP: Discipline: Physiology
MSC: Organ System: Nervous
34. Pallor of the lips and mucous membranes is one sign of a. anemia. b. hyperbilirubinemia. c. liver problems. d. carbon monoxide poisoning. e. Peutz-Jeghers syndrome. ANS: A
Pallor is an associated sign of anemia. REF: p. 245 TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 35. A smooth red tongue with a slick appearance may indicate a. a niacin or vitamin B12 deficiency. b. oral cancer. c. recent use of antibiotics. d. a fungal infection. e. a geographic tongue. ANS: A
A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Oral cancer involves lesions; recent use of antibiotics can turn the tongue yellow-brown to black and hairy; and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. A geographic tongue has irregular areas of whitish and red areas. REF: p. 247 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 36. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa
are a. b. c. d. e.
Fordyce spots. aphthous ulcers. Stensen ducts. leukoedema. angular cheilitis.
ANS: B
Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa. REF: p. 246 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 37. A hairy tongue with yellowish brown to black elongated papillae on the dorsum a. is indicative of oral cancer. b. is sometimes seen after antibiotic therapy.
c. usually indicates a vitamin deficiency. d. usually indicates anemia. e. is characteristic of a geographic tongue. ANS: B
Recent antibiotic use can turn the tongue yellow-brown to black and hairy. REF: p. 247 TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal 38. To inspect the lateral borders of the tongue, you should a. ask the patient to extend the tongue outward. b. insert the tongue blade obliquely against the tongue. c. lift the tongue upward with gloved fingers. d. pull the gauze-wrapped tongue to each side. e. ask the patient to lift the tongue upward. ANS: D
To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. The other maneuvers do not result in adequate lateral border inspection. REF: p. 247 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 39. A 6-month-old who can hear well can be expected to a. exhibit the Moro reflex. b. stop breathing in response to sudden noise. c. turn his or her head toward the source of sound. d. imitate simple words. e. understand simple phrases. ANS: C
Six-month-old infants turn their heads toward the source of sound, and they start babbling, but they begin imitating speech sounds closer to 10 months of age. Understanding simple phrases such as “no-no” and “bye-bye” occurs between 10 and 12 months. The Moro reflex and cessation of breathing in response to noise are lost by 3 months of age. REF: p. 250
TOP: Discipline: Physiology
MSC: Organ System: Nervous
40. Which variation may be an expected finding in the ear examination of a newborn? a. Diffuse light reflex b. Purulent material in the ear canal c. Redness and swelling of the mastoid process d. Small perforations of the tympanic membrane e. Increased mobility and clarity of the tympanic membrane ANS: A
The newborn’s tympanic membrane does not become conical for several months; therefore, the light reflex appears diffuse. REF: p. 249
TOP: Discipline: Physiology
MSC: Organ System: General
41. For best results, an otoscopic and oral examination in a child should be a. conducted at the beginning of the assessment. b. done after inspection. c. performed at the end of the examination. d. performed before palpation. e. deferred until they can fully cooperate. ANS: C
Because young children often resist otoscopic and oral examination, it may be wise to postpone these procedures until the end of the examination after you have gained some trust. REF: p. 251
TOP: Discipline: Physiology
MSC: Organ System: General
42. Which pediatric patient complaints would you refer immediately to the emergency
department? a. A patient with a temperature of 100.4° F and a toothache b. A drooling patient with muffled voice and stridor c. A patient with purulent drainage from the ear and a cough d. A patient with a seal-like barking cough and anorexia e. A patient whose epiglottis is visible when the tongue is depressed ANS: B
Suspected retropharyngeal abscess, which can cause drooling, a muffled voice, and stridor, is a pediatric emergency because it occludes the airway. REF: p. 259 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 43. Which abnormality is common during pregnancy? a. Eruption of additional molars b. Hypertrophy of the gums c. Epstein pearls d. Otitis media e. Koplik spots ANS: B
The gums of pregnant women may appear reddened, swollen, and spongy, with the hypertrophy resolving within 2 months of delivery. REF: p. 253
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
44. Expected physical changes associated with older adults include a. shiny buccal mucosa. b. teeth appear shorter. c. wetter nasal mucosa. d. bristly hairs in the vestibule. e. smoothing of the tongue. ANS: D
With age, the buccal mucosa becomes less shiny, the teeth appear longer because of receding gums, the nasal mucosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men. REF: p. 253 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 45. Intense pain with movement of the pinna is most closely associated with a. sinusitis. b. otitis externa. c. purulent otitis media. d. bacterial otitis media. e. otitis media with effusion. ANS: B
Suspect otitis externa (swimmer’s ear) when pulling the pinna reproduces ear pain. The other conditions do not commonly cause the same finding. REF: p. 256
TOP: Discipline: Pathophysiology
MSC: Organ System: General
46. Severe vertigo, tinnitus, and progressive hearing loss are characteristic of a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. e. labyrinthitis. ANS: B
The classic triad of Ménière disease is vertigo, tinnitus, and progressive hearing loss. REF: p. 257
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
47. Which of the following illicit drugs is commonly associated with nasal septum perforation? a. Heroin b. Marijuana c. PCP d. Ecstasy e. Cocaine ANS: E
Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to perforation of the nasal septum. REF: p. 243 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 48. Evidence-based practice suggests that the strongest predictor of sinusitis is a. a maxillary toothache. b. dull or opaque sinus transilluminations. c. ineffective decongestants and colored nasal drainage. d. purulent nasal secretions. e. any combination of the above.
ANS: E
Evidence-based practice suggests that the strongest predictor of sinusitis is any combination of these symptoms including maxillary toothache, purulent nasal secretions, dull or opaque sinus transillumination, poor response to decongestants, and colored nasal discharge. REF: p. 244
TOP: Discipline: Pathophysiology
MSC: Organ System: General
49. You are interviewing a parent whose child has a fever, is batting at her right ear, and is
irritable. You ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional finding is most suggestive of a. acute otitis media. b. otitis externa. c. serous otitis media. d. middle ear effusion. e. cerumen impaction. ANS: A
Anorexia is an initial symptom of acute otitis media and is not found with cerumen impaction or otitis externa or with conditions of fluid in the middle ear. REF: p. 256
TOP: Discipline: Pathophysiology
MSC: Organ System: General
Chapter 13: Chest and Lungs Test Bank—Medical MULTIPLE CHOICE 1. Which chest structure contains all the thoracic viscera except the lungs? a. Manubrium b. Mediastinum c. Sternum d. Xiphoid e. Pleural cavities ANS: B
The mediastinum, situated between the lungs, contains all the thoracic viscera except the lungs. The manubrium and xiphoid are parts of the sternum. The pleural cavities enclose the lungs. REF: p. 260 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 2. Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies? a. Left mainstem bronchus b. Terminal bronchioles c. Right mainstem bronchus d. Right respiratory bronchioles e. Left respiratory bronchioles ANS: C
The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotracheal tubes that are advanced too far. REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 3. When auscultating the apex of the lung, you should listen a. even with the second rib. b. 4 cm above the first rib. c. higher on the right side. d. on the convex diaphragm surface. e. directly over the clavicles. ANS: B
The apices of the lungs are 4 cm above the first rib. REF: p. 262 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 4. You are documenting a rash between the eighth and ninth ribs on the lateral border. This
intercostal space will be documented in terms of the a. rib immediately above it.
b. c. d. e.
rib immediately below it. number of centimeters it is positioned below the clavicle. number of inches it is positioned below the clavicle. relationship to the sternum.
ANS: A
The number of each intercostal space corresponds to that of the rib immediately above it. REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 5. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference
point of the a. distal point of the xiphoid. b. manubriosternal junction. c. suprasternal notch. d. acromion process. e. clavicle. ANS: B
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second rib, the reference point for counting ribs and intercostal spaces. REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 6. Fetal gas exchange is mediated by the a. pleura. b. heart. c. amniotic fluid. d. placenta. e. lungs. ANS: D
The placenta is the source for fetal gas exchange; the lungs contain no air, and the alveoli are collapsed. REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 7. The foramen ovale should close by a. 24 weeks of gestation. b. the initiation of labor. c. within minutes of birth. d. 4 weeks of age. e. 12 months of age. ANS: C
The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale. REF: p. 264
TOP: Discipline: Physiology
MSC: Organ System: Pulmonary/Respiratory 8. Increased oxygen tension in the arterial blood of a newborn infant causes a. closure of the ductus arteriosus. b. hyperinflation of the lungs. c. passive respiratory movements. d. reopening of the foramen ovale. e. the pulmonary arteries to contract. ANS: A
Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus. REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 9. The anteroposterior diameter of the chest is normally approximately the same as the
transverse diameter in which age group? a. Infants b. School-age children c. Adolescents d. Young adults e. Older adults ANS: A
The chests of infants are generally round, with equal dimensions of anteroposterior and transverse diameters. REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 10. To accommodate the enlarging uterus of pregnancy, the chest changes result in a. intercostal muscle atrophy. b. lowering of the resting diaphragm. c. decreased alveoli expansion. d. decreased diaphragmatic movement. e. increased costal angle. ANS: E
The costal angle progressively increases from approximately 68.5 degrees to 103.5 degrees in later pregnancy. The resting diaphragm rises, yet diaphragmatic movement increases, the alveolar ventilation and tidal volume increase, and the muscles do not atrophy. REF: p. 265 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 11. The characteristic barrel chest of an older adult is caused by a combination of factors,
including a. skeletal changes of aging. b. increased muscular expansion of the chest wall. c. less fibrous alveoli. d. increased vital capacity.
e. increased lung resiliency. ANS: A
Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest. REF: p. 265 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 12. Nancy is a 16-year-old young woman who presents to the clinic with complaints of severe,
acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What potential risk factor is most important to assess concerning Nancy’s present problem? a. Anorexia symptoms b. Illegal drug use c. Last menses d. Signs of rheumatic fever e. Sexual activity ANS: B
Illegal drug use, particularly of cocaine, is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine use can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax. REF: p. 267 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 13. A patient describes shortness of breath that gets worse when he sits up. Which term
documents this? a. Platypnea b. Orthopnea c. Tachypnea d. Bradypnea e. Hypopnea ANS: A
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens with lying down, tachypnea is increased respiratory rate, and bradypnea is decreased respiratory rate. Hypopnea refers to abnormally shallow respirations. REF: p. 266 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 14. Bradypnea may accompany a. pneumothorax. b. an excellent level of cardiovascular fitness. c. ascites. d. a pulmonary embolus. e. anxiety. ANS: B
Bradypnea, a rate slower than 12 breaths/min, may result from cardiorespiratory fitness. The other choices accompany tachypnea. REF: p. 270 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 15. A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that
is more intense with deep breathing and coughing. Upon auscultation of the chest, you suspect that you will hear a. rhonchi. b. expiratory wheeze. c. crackles. d. pleural friction rub. e. crepitus. ANS: A
This patient is describing the bronchi as the source of the pain; the trachea divides at T4–5, between the shoulder blades. The adventitious bronchial sound expected is rhonchi. Wheezing might be expected if the patient had productive coughing or dyspnea; a pleural friction rub usually causes sudden stabbing pain over the pleuritic site. Crepitus can be both palpated and heard; it indicates air in the subcutaneous tissue and is usually found anteriorly and toward the axilla. REF: p. 279 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 16. The most appropriate lighting source to highlight chest movement is (are) a. bright tangential lighting. b. daylight from a window. c. flashlight in a dark room. d. fluorescent ceiling lights. e. a Wood’s lamp. ANS: A
Bright tangential light is best to visualize chest movements. REF: p. 268 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 17. Both pleural effusion and lobar pneumonia are characterized by _____ percussion. a. tympany heard with b. dullness heard on c. resonance heard on d. hyperresonance heard on e. occasional hyperresonance heard on ANS: B
Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness to percussion. Tympany is expected over hollow organs such as the stomach; resonance and hyperresonance are heard over air-filled areas. REF: p. 274
TOP: Discipline: Pathophysiology
MSC: Organ System: Pulmonary/Respiratory 18. Which finding suggests a minor structural variation? a. Barrel chest b. Clubbed fingers c. Pectus carinatum d. Retractions e. Tachypnea ANS: C
Barrel chest, clubbed fingers, chest wall retractions, and tachypnea result from compromised respirations; pectus carinatum (pigeon chest) is a minor structural variation. REF: p. 268 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 19. Ms. R, age 74 years, has no known health problems or diseases. You are doing a preventive
health care history and examination. Which symptom is associated with an intrathoracic infection? a. Barrel chest b. Cor pulmonale c. Pectus excavatum d. Pectus carinatum e. Malodorous breath ANS: E
Intrathoracic infections may make the breath malodorous; the other conditions will not. REF: p. 273 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 20. In barrel chest, the ratio of the anteroposterior diameter to the transverse (lateral) diameter is a. 0.7 to 0.75. b. 1.0. c. 1.3 to 1.5. d. 1.5 to 2. e. greater than 2. ANS: B
In a barrel chest, an increase in the chest anteroposterior diameter leads to an increase in the thoracic ratio (anteroposterior to transverse diameters) of 1.0, in which the chest is equally wide as it is thick. REF: p. 265 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 21. The patient that you are examining is complaining of pain near the spine. While palpating the
spinous process at T7 and medially to the inferior border of the right scapula, the patient feels more intense pain. When viewing the chest radiograph, you will carefully look at which rib? a. Right sixth rib b. Right seventh rib c. Right eighth rib
d. Left seventh rib e. Left eighth rib ANS: C
Although each rib articulates with the corresponding vertebra, the palpated spinous process dips down so that the rib you feel in apparent association with the spinous process is actually the number of that process plus 1. REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 22. The best time to observe and count respirations is a. while the patient is answering questions. b. while weighing the patient. c. after palpating the pulse. d. when the patient is sleeping. e. after a short walk. ANS: C
Respiratory patterns change as the patient speaks and sleeps. Attempting to count during weighing would make the patient self-conscious and affect the respiratory rate. Counting respirations after you palpate the pulse does not make the patient self-conscious because the patient expects you to be counting the pulse. REF: p. 270 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 23. As you take vital signs on Mr. B, age 78 years, you note that his respirations are 40
breaths/min. He has been resting, and his mucosa is pink. Concerning Mr. B’s respirations, you would a. document his rate as normal. b. do nothing because his color is pink. c. note that his rate is below normal. d. report that he has an above-average rate. e. ignore one abnormal result. ANS: D
The normal adult respiratory rate is 12 to 20 breaths/min, with a ratio of respirations to heartbeats of 1:4. Always note any variations in respiratory rate. REF: p. 270 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 24. In which patient situation would you expect to assess tachypnea? a. Patient with depression b. Patient who abuses narcotics c. Patient with metabolic acidosis d. Patient with myasthenia gravis e. Patient with metabolic alkalosis ANS: C
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the excess carbon dioxide. The other choices cause respiratory depression. REF: p. 270 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 25. What term would you use to document a respiratory rate greater than 20 breaths/min in an
adult? a. Dyspnea b. Orthopnea c. Platypnea d. Tachypnea e. Cheyne-Stokes ANS: D
Tachypnea is the correct term for respirations greater than 20 breaths/min. Dyspnea, orthopnea, and platypnea are terms that describe respiratory effort, not rate. Cheyne-Stokes refers to a particular abnormal pattern of respiration. REF: p. 270 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 26. Respiratory effort usually exhibited by the patient with cerebral brain damage is called a. Cheyne-Stokes respiration. b. paroxysmal nocturnal dyspnea. c. Kussmaul breathing. d. Biot respiration. e. ataxic respiration. ANS: A
Cheyne-Stokes respirations occur in children and older adults during sleep but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. The other choices are not apnea associated with cerebral damage. REF: p. 271 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 27. Which site of chest wall retractions indicates a more severe obstruction in a patient with
asthma? a. Lower chest b. Along the anterior axillary line c. Above the clavicles d. At the nipple line e. Along the posterior axillary line ANS: C
Asthma more commonly produces retractions of the lower chest. The more severe the obstruction, the greater is the negative pressure produced in the chest during inspiration and retractions are seen in the upper thorax. REF: p. 282 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
28. Which type of apnea requires immediate action? a. Primary apnea b. Secondary apnea c. Sleep apnea d. Periodic apnea of the newborn e. Apnea of prematurity ANS: B
Primary apnea is self-limiting, sleep apnea should be evaluated but does not require immediate action, and periodic apnea of the newborn is a normal condition. Apnea of prematurity is a more intense version of periodic apnea of the newborn. Secondary apnea is grave, and unless resuscitative measures are immediately instituted, breathing will not resume spontaneously. REF: p. 271 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 29. Laryngeal obstructions would elicit which breath sound? a. Fremitus b. Stridor c. Rhonchi d. Crepitus e. Wheezing ANS: B
Obstructions high in the respiratory tree are characterized by stridor. REF: p. 272 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 30. Mr. L has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect
that he has cardiac or pulmonary difficulty. What additional sign would correspond with your impression? a. Callus formation on the heels b. Clubbing of the fingers c. Graying of the hair d. Swollen toes and ankles e. Positioning of the head ANS: B
Clubbing of the fingers suggests chronic pulmonary or cardiac difficulty. The other choices do not. REF: p. 273 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 31. Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of
ammonia on the breath may signify a. uremia. b. tuberculosis. c. hepatic dysfunction.
d. diabetic ketoacidosis. e. intestinal obstruction. ANS: A
The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis, a musty fish or clover odor suggests hepatic failure, a sweet and fruity odor suggests diabetic ketoacidosis; and a foul or feculent odor suggests intestinal obstruction. REF: p. 277 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 32. An expected finding from chest palpation in the adult would be a. costal angle of 120 degrees. b. cracking over the sternal notch. c. greater right chest expansion. d. crepitus. e. inflexibility of the xiphoid. ANS: E
The sternum and xiphoid in adults are relatively inflexible, without cracking; the expected normal costal angle is 90 degrees, and the chest moves symmetrically. Crepitus is always an abnormal finding. REF: p. 273 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 33. You would expect to document the presence of a pleural friction rub for a patient being treated
for a. b. c. d. e.
bronchitis. atelectasis. pleurisy. emphysema. pneumonia.
ANS: C
A pleural friction rub is caused by inflammation of the pleural surfaces and is expected to be auscultated with pleurisy. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 34. Tactile fremitus is best felt a. along the costal margin and xiphoid process. b. in the suprasternal notch along the clavicle. c. at the level of bifurcation of the bronchi. d. posterolaterally over the scapulas. e. in the midaxillary lines. ANS: C
Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. There is great variability depending on the intensity and pitch of the voice and the structure and thickness of the chest wall. In addition, the scapulae obscure fremitus.
REF: p. 273 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 35. In the most effective percussion technique of the posterior lung fields, the patient cooperates
by a. b. c. d. e.
folding the arms in front. bending the head back. standing and bending forward. lying on the side and extending the top arm. lying prone.
ANS: A
Asking the patient to sit with the head forward and arms folded in front moves the scapula laterally, exposing more lung to percussion. REF: p. 274 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 36. The examiner percusses for diaphragmatic excursion along the a. vertebral column. b. midvertebral line. c. midaxillary line. d. scapular line. e. sternum. ANS: D
The technique for diaphragmatic excursion is to percuss along the scapular line, after the patient inhales deeply, and to mark the site when resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation. REF: p. 276 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 37. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it a. amplifies all types of sounds. b. filters extraneous sounds. c. pinpoints focal sound areas. d. transmits high-pitched sounds. e. transmits low-pitched sounds. ANS: D
Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung and has a broader area from which to listen. REF: p. 277 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 38. Breath sounds normally auscultated over most of the lung fields are called a. vesicular.
b. c. d. e.
hyperresonance. bronchial. tubular. bronchovesicular.
ANS: A
The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds. REF: p. 277 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 39. Breath sounds normally heard over the trachea are called a. bronchovesicular. b. amphoric. c. crepitus. d. vesicular. e. bronchial. ANS: E
The highest sounds in intensity and pitch are called the bronchial sounds, which are normally heard over the trachea. REF: p. 278 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 40. When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear,
whereas healthy lung tissue produces softer sounds. This is because a. consolidation will echo in the chest. b. consolidation is a poor conductor of sound. c. air-filled lung sounds are from smaller spaces. d. air-filled lung tissue is an insulator of sound. e. consolidation causes hyperinflation of the lungs. ANS: D
Whereas air is a poor conductor of sound, more dense consolidation promotes louder sounds and is a better conductor of sound. REF: p. 278 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 41. The middle lobe of the right lung is best auscultated over the a. anterior chest. b. posterior chest. c. axilla. d. midclavicular line. e. scapula. ANS: C
The sounds of the middle lobe of the right lung are best heard in the right axilla. REF: p. 262
TOP: Discipline: Physiology
MSC: Organ System: Pulmonary/Respiratory 42. Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia.
The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by a. percussing all lung fields. b. auscultating the lung bases. c. determining tactile fremitus. d. estimating diaphragmatic excursion. e. auscultating the apices. ANS: B
Because the patient has consolidation and has been recumbent and fatigued, the most appropriate first step is to listen to the lung bases before the patient gets exhausted. The lung bases would be the most likely sites for adventitious sounds. REF: p. 277 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 43. Your trauma patient has no auscultated breath sounds in the right lung field. You can hear
adequate sounds in the left side. A likely cause of this abnormality could be that the patient a. has a closed head injury. b. has minimal fluid in the pleural space. c. is moaning and in severe pain. d. is receiving high oxygen flow. e. has a pneumothorax. ANS: E
Trauma to the chest can cause an exudative pleural effusion or pneumothorax. In the affected areas, the breath sounds are diminished to absent. REF: p. 285 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 44. Adventitious breath sounds previously referred to as rales has been replaced with the term a. wheezes. b. crunches. c. vesicular. d. crackles. e. rhonchi. ANS: D
The term rales has been replaced with the term crackles to describe the sound more precisely. REF: p. 279 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 45. To distinguish crackles from rhonchi, you should auscultate the lungs a. before and after the patient coughs. b. first at the lung base and then at the apex. c. with the patient inhaling and then exhaling. d. with the patient prone and then supine.
e. with the patient recumbent and then sitting. ANS: A
To distinguish between crackles and rhonchi, ask the patient to cough and auscultate again over the same area. Rhonchi, because they represent secretions in larger airways, can clear with coughing. REF: p. 279 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 46. A musical squeaking noise heard on auscultation of the lungs is called a. stridor. b. rales. c. rhonchi. d. wheezing. e. friction rub. ANS: D
Wheezes are continuous, high-pitched musical sounds that can be heard on inspiration and expiration. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 47. To distinguish between a respiratory friction rub and a cardiac friction rub, ask the patient to a. hold his or her breath. b. lean forward. c. say “99” while you palpate the anterior chest. d. identify the location of his or her pain. e. arch backward. ANS: A
A respiratory friction rub results from inflamed pleura rubbing against each other during the respiratory cycle, so if the breath is held, the rub stops. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 48. In what position can the mediastinal crunch (Hamman sign) be heard best? a. In a supine position b. Lying on the left side c. Sitting completely upright d. With the head elevated 30 degrees e. In a prone position ANS: B
The Hamman sign is heard with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side—these maneuvers bring the heart muscle closer to the chest wall. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
49. Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you
distinguish a. crepitus from stridor. b. a foreign body from a purulent exudate. c. pulmonary edema from pleurisy. d. a right from left tracheal deviation. e. consolidation from airway constriction. ANS: E
When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish these adventitious breath sounds as a result of consolidation rather than narrowing of a patent lumen. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 50. During chest assessment, you note the patient’s voice quality while auscultating the lung
fields. The voice sound is intensified, there is a nasal quality to the voice, and the e’s sound like a’s. This is indicative of a. lung consolidation. b. emphysema. c. bronchial obstruction. d. pneumothorax. e. asthma. ANS: A
Vocal resonance, as described, indicates lung consolidation. Sounds are transmitted more clearly through consolidation rather than air. Conditions of air trapping such as emphysema and asthma would not produce vocal resonance sounds; bronchial obstruction would more likely result in a wheeze. Pneumothorax would result in diminished or no breath sounds. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 51. During chest assessment, you note the patient’s voice quality while you are auscultating the
lung fields. The voice sound is intensified, there is a nasal quality to the voice, and e’s sound like a’s. This sound described is called a. sonorous. b. bronchophony. c. pectoriloquy. d. egophony. e. resonance. ANS: D
When the intensity of the spoken voice is increased, there is a nasal quality in which the e’s become stuffy broad a’s. This technique is called egophony. REF: p. 280 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 52. How is the sputum of a viral infection different from the sputum of a bacterial infection?
a. There is more sputum production with viral conditions than bacterial infections. b. The sputum is odorous with viral conditions and nonodorous with bacterial
infections. c. The sputum is yellow, green, or rust colored with bacterial infections and mucoid
with viral. d. The sputum is much thinner with bacterial infections and viscid with viral. e. Viral pneumonia sputum is never blood streaked. ANS: C
The more likely differentiating characteristic between viral and bacterial sputum is the color. Whereas viral infections typically produce mucoid sputum, bacterial infections produce yellow, green, or rust-colored sputum. REF: p. 266 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 53. The respiratory rate of a newborn infant is expected to range from _____ breaths/min. a. 10 to 20 b. 20 to 30 c. 40 to 60 d. 30 to 80 e. greater than 80 ANS: C
The expected rate varies from 40 to 60 respirations per minute, although a rate of 80 is not uncommon REF: p. 281 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 54. A signal for alarm during newborn chest assessment is a. crackles. b. rhonchi. c. gurgles from the gastrointestinal tract. d. stridor. e. a mobile xiphoid. ANS: D
Crackles and rhonchi at birth are caused by the presence of remaining fetal fluid; intermittent gurgles are transmitted bowel sound through the thin-walled chest and are not alarming; stridor is alarming at any age. The newborn’s xiphoid process is more mobile and prominent than in older children. REF: p. 281 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 55. Bronchovesicular breath sounds in young children that are loud and harsh are an indication of a. an accumulation of fluid. b. malignant tumors or solid masses. c. normal, thin chest wall structures. d. pus-filled abscesses and tumors. e. tension pneumothorax.
ANS: C
Young children’s chest walls are usually thin and therefore able to normally transmit loud, harsh, and more bronchial breath sounds than can adults. REF: p. 282 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 56. The pregnant woman is expected to develop a. tachypnea and decreased tidal volume. b. deep breathing but not more frequent breathing. c. dyspnea and increased functional residual capacity. d. bradypnea and increased tidal volume. e. tachypnea and increased functional residual capacity. ANS: B
In pregnant women, tidal volume and vital capacity increase, and functional residual capacity decreases. Also, pregnant women breathe more deeply but not more frequently. REF: p. 282 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 57. Expected respiratory changes of normal aging include a. increased chest expansion. b. more frequent use of respiratory muscles. c. accentuated lumbar curve. d. more prominent bony structures. e. flattening of the dorsal thoracic curve. ANS: D
In older adults, chest expansion is decreased, and there is less use of respiratory muscles because of muscle weakness. The dorsal curve of the thoracic spine is prominent with flattening of the lumbar curve with bony landmarks becoming more prominent because of loss of subcutaneous tissue. REF: p. 282 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 58. Dullness to percussion in intercostal spaces is most consistent with the presence of a. asthma. b. empyema. c. pneumonia. d. sickle cell disease. e. pneumothorax. ANS: C
The expected percussion tone over normal lung tissue, accessible in the intercostal spaces, is resonance. Dullness would indicate an area of consolidation, as is seen with pneumonia. REF: p. 274 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
59. Which condition requires immediate emergency intervention? a. Patient with pleuritic pain without dyspnea b. Patient with fever and a productive cough c. Patient with tachypnea but no chest retractions d. Patient with pleuritic pain and rib tenderness e. Patient with absent breath sounds and dull percussion tones ANS: A
A patient who experiences unexpected pleuritic pain without prior respiratory distress or dyspnea has most likely developed a pulmonary embolism, a condition with a high mortality rate. REF: p. 290 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 60. A 29-year-old patient presents with a new complaint of productive cough with purulent
sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in the _____ lobe. a. right lower b. right middle c. right upper d. left upper e. left lower ANS: A
Right lower lobe pneumonia can stimulate the tenth and eleventh thoracic nerves, causing right lower quadrant pain, and simulate an abdominal process. REF: p. 288 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 61. Epiglottitis has frequently associated with infection by which organism? a. Respiratory syncytial virus b. Haemophilus influenzae type B c. Adenovirus d. Parainfluenza virus e. Human metapneumovirus ANS: B
Epiglottitis is an acute inflammation of the epiglottis caused by bacterial invasion. Immunization against the bacterium Haemophilus influenzae type B has greatly reduced the incidence in the United States. All of the other choices are viruses associated with bronchiolitis. REF: p. 291 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory
Chapter 14: Heart Test Bank—Medical MULTIPLE CHOICE 1. The condition in which a patient’s heart is either rotated or displaced to the right or is situated
as a mirror image of the expected position is called a. amyloidosis. b. cardiomyopathy. c. dextrocardia. d. situs inversus. e. coarctation. ANS: C
Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Cardiomyopathy is the deterioration of heart muscle function. Coarctation is the compression of the walls of a vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left. REF: p. 294 TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular 2. Heart position can vary depending on body habitus. In a short, stocky individual, you would
expect the heart to be located a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. e. more to the right and lying more horizontally. ANS: B
The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person’s heart tends to hang vertically and is positioned centrally. A stocky, short person’s heart tends to lie more to the left and more horizontally. REF: p. 294 TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular 3. Thin-walled reservoirs of the heart are the a. atria. b. pericardia. c. sinuses. d. ventricles. e. septa. ANS: A
The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the venous system. The pericardium is a double-walled membranous fibroserous sac enclosing the heart and the bases of the great vessels. A sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The ventricles are the primary muscle mass of the heart. The left heart and right heart are divided by a blood-tight partition called the cardiac septum. REF: p. 295 TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular 4. Which cardiac structure is responsible for the heart’s pumping action? a. Pericardium b. Epicardium c. Myocardium d. Endocardium e. Atria ANS: C
The myocardium is the thick muscular middle layer that is responsible for the pumping action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects the heart. The epicardium is the thin outermost muscle layer that covers the heart and extends onto the great vessels. The endocardium is the innermost layer that lines the chambers of the heart and covers heart valves. The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the veins throughout the body. REF: p. 295 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 5. Which two heart structures are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle e. Superior and inferior venae cavae ANS: C
The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cavae lie posteriorly. REF: p. 295 TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular 6. Contraction of the ventricles causes a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the mitral valve and closure of the tricuspid valve. d. opening of the mitral and tricuspid valves. e. opening of the auricular septa.
ANS: A
When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles. REF: p. 297 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 7. Which two structures together form the primary muscle mass of the heart? a. Right atria and left ventricle b. Left ventricle and the aorta c. Right and left atria d. Left atrium and the pulmonary vein e. Right and left ventricles ANS: E
The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atrium pumps blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria. REF: p. 295 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 8. The major heart sounds are normally created by a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the cardiac walls. e. pulmonic veins. ANS: B
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 “lubb.” When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 “dubb.” Valve opening is usually a silent event. REF: p. 297 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 9. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of
the stimulus through the atria is the a. P wave. b. PR interval. c. QRS complex. d. ST segment.
e. T wave. ANS: A
The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization). REF: p. 299 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 10. A third heart sound is created by a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles. e. blood in the pericardium. ANS: C
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3. REF: p. 298 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 11. The “pacing” structure of the heart’s electrical activity is the a. atrioventricular (AV) node. b. bundle of His. c. Purkinje fibers. d. coronary sinus. e. sinoatrial (SA) node. ANS: E
An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node. REF: p. 299 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 12. Purkinje fibers are located in the a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch. e. pericardium. ANS: C
The Purkinje fibers are located in the ventricular myocardium. REF: p. 299
TOP: Discipline: Physiology
MSC: Organ System: Cardiovascular 13. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the
ECG as the a. P wave. b. QRS complex. c. PR interval. d. T wave. e. U wave. ANS: B
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave. REF: p. 299 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 14. In a fetus, the right ventricle pumps blood through the a. left atrium. b. ductus arteriosus. c. lungs. d. foramen ovale. e. septum primum. ANS: B
The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs. REF: p. 300 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 15. In what group are the right and left ventricles equal in weight and muscle mass? a. Newborns b. School-age children c. Adolescents d. Older adults e. Pregnant women ANS: A
At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and the interatrial foramen ovale cause pressure in the left atrium to increase. At this time, the right ventricles demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older adults, the left ventricle wall thickens, and the valves become fibrotic and calcified. In pregnant women, the left ventricle increases in both wall thickness and mass. REF: p. 300
TOP: Discipline: Physiology
MSC: Organ System: Cardiovascular 16. Closure of the ductus arteriosus usually occurs a. just before the initiation of labor. b. 24 to 48 hours after birth. c. after 7 days of life. d. between the second and third months of life. e. during the toddler stage. ANS: B
Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth. REF: p. 300 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 17. The apex of a 2-month-old baby’s heart typically lies closest to the a. left midsternal area. b. fourth left intercostal space. c. midthoracic spinal area. d. sixth left intercostal space. e. right midsternal area. ANS: B
In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space. REF: p. 300 TOP: Discipline: Gross Anatomy MSC: Organ System: Cardiovascular 18. Normal cardiac changes that occur during pregnancy include a. decreased cardiac output. b. increased thickness and mass of the left ventricle. c. decreased heart rate. d. dilation of the ventricles. e. heart is shifted more vertical. ANS: B
The maternal blood volume increases by 40% to 50% because of an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally, and there is a slight axis rotation. REF: p. 300 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 19. Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation
e. Atrial fibrillation ANS: D
Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation. REF: p. 327 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 20. Mr. O, age 50 years, comes for his yearly health assessment, which is provided by his
employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should a. ask if he makes his own bed daily. b. have the patient describe his exercise. c. make a note that he walks each day. d. record “light exercise” in the history. e. record “questionable exercise” in the history. ANS: B
When Mr. O says he engages in light exercise, have him describe his exercise. To qualify his use of the term “light,” ask him the type, length of time, frequency, and intensity of his activities. REF: p. 304 TOP: Discipline: Behavioral Science MSC: Organ System: Cardiovascular 21. Pleural pain differs from chest discomfort caused by other conditions in that it is a. precipitated by breathing. b. eased with deep breathing. c. usually described as dull in nature. d. related to the time of day. e. eased with coughing. ANS: A
Pleural pain is precipitated by breathing and coughing and is usually described as a sharp pain that is present during respirations and absent during breath-holding. Angina is substernal and is provoked by effort, emotion, or eating; it is relieved by rest or nitroglycerin. Angina is usually accompanied by diaphoresis and occasionally by nausea. REF: p. 302 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 22. Which of the following information belongs in the past medical history section related to heart
and blood vessel assessment? a. Adolescent inguinal hernia b. Childhood mumps c. Past incidence of bee stings d. Previous unexplained fever e. Parents with a history of cardiac problems ANS: D
Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage. REF: p. 303 TOP: Discipline: Behavioral Science MSC: Organ System: Cardiovascular 23. A patient you are seeing in the emergency department for chest pain is suspected of having a
myocardial infarct. During the health history interview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following? a. “Did your father have coronary bypass surgery?” b. “Did your father’s father have heart trouble also?” c. “What were your father’s usual dietary habits?” d. “What age was your father at the time of his death?” e. “Did your mother also have heart trouble?” ANS: D
A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one’s chance of a similar occurrence. REF: p. 303 TOP: Discipline: Behavioral Science MSC: Organ System: Cardiovascular 24. Which one of the following is a common symptom of cardiovascular disorders in an older
adult? a. Fatigue b. Joint pain c. Poor night vision d. Urticaria e. Fevers ANS: A
Common symptoms of cardiovascular disorders in older adults include confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or tightness, impotence, fatigue, and leg edema. REF: p. 304 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 25. In an adult, the apical impulse should be most visible when the patient is in which position? a. Supine b. Leaning backward c. Lithotomy d. Right lateral recumbent e. Upright ANS: E
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. REF: p. 305 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 26. If the apical impulse is more vigorous than expected to the chest wall, it is called a. a lift. b. a thrill. c. a bruit. d. a murmur. e. crepitus. ANS: A
The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations. REF: p. 306 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 27. A palpable rushing vibration over the base of the heart at the second intercostal space is called
a a. b. c. d. e.
heave. lift. thrill. thrust. murmur.
ANS: C
A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow. REF: p. 306 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 28. An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may
indicate a. decreased cardiac output. b. dextrocardia. c. left ventricular hypertrophy. d. hyperventilation. e. obesity.
ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right. REF: p. 306 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 29. A lift along the left sternal border is most likely the result of a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy. e. left ventricular hypertrophy. ANS: D
A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect. REF: p. 306 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 30. To estimate heart size by percussion, you should begin tapping at the a. apex. b. left sternal border. c. midclavicular line. d. midsternal line. e. anterior axillary line. ANS: E
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border. REF: p. 306 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 31. Normal heart sounds are best heard a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum. e. over the ribs. ANS: B
Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow.
REF: p. 307 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 32. To hear diastolic heart sounds, you should ask patients to a. lie on their backs. b. lie on their left sides. c. lie on their right sides. d. sit up and lean forward. e. lie prone. ANS: B
The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia. REF: p. 308 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 33. The carotid pulse should coincide with which heart sound? a. S1 b. S2 c. S3 d. S4 e. S3-4 ANS: A
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound. REF: p. 306 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 34. You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound
becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following? a. S1 b. S2 c. S3 d. S4 e. S3-4 ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration. REF: p. 308 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
35. During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split.
You should ask the patient to inhale deeply while listening at the _____ area. a. aortic b. pulmonic c. tricuspid d. mitral e. apex ANS: B
Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site. REF: p. 309 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 36. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing a. the splitting of S2. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. e. pericardial friction rub. ANS: C
Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position. REF: p. 308 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 37. You are conducting an examination of Mr. C’s heart and blood vessels and auscultate a grade
III murmur. The intensity of this murmur is a. barely discernible. b. quiet but audible. c. moderately loud. d. loud with palpable thrill. e. very loud without a stethoscope. ANS: C
The intensity of a grade III murmur is described as moderately loud. Barely loud is a grade I murmur, quiet but clearly audible is a grade II, loud with a palpable thrill is a grade IV, and very loud without a stethoscope is a grade VI. REF: p. 313 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 38. A grade I or II murmur, without radiation and of medium pitch, is a common variation found
in a. school-age children. b. older women. c. middle-aged men.
d. sedentary individuals. e. older adults. ANS: A
Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2. REF: p. 317 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 39. An example of a functional heart murmur is one that is caused by a. anemia. b. a ventricular septal defect. c. an atrial septal defect. d. mitral valve prolapse. e. a leaking aortic valve. ANS: A
Not all murmurs are the result of valvular defects made by a healthy heart beating strongly, high-output demands that increase the speed of blood flow can cause murmurs. Anemia, pregnancy, and thyrotoxicosis can cause these functional heart murmurs. REF: p. 314 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 40. A split second heart sound is a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration. e. always accompanied by a thrill. ANS: B
Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill. REF: p. 319 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 41. The earliest sign of heart failure in an infant is frequently a. an apical impulse in the fourth intercostal space. b. moisture in the lungs. c. enlarged thyroid. d. clubbing of the fingers. e. liver enlargement. ANS: E
If heart failure is suspected, note that the infant’s liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding. REF: p. 318 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 42. Chest pain in a child with an organic cause is more likely the result of a. cardiac disease. b. asthma. c. esophageal reflux. d. arthritis. e. peptic ulcer disease. ANS: B
Unlike chest pain in adults, chest pain in children and adolescents seldom is caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use. REF: p. 302 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 43. Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus arrhythmia e. Third-degree AV block ANS: D
Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension. REF: p. 319 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 44. An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an
expected finding in a. adults under stress. b. 4-year-old children. c. pregnant women. d. older adults. e. premature infants. ANS: B
Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child varies in a cyclic pattern, usually faster on inspiration and slow on expiration. REF: p. 319 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
45. A condition that is likely to present with dizziness and fainting is a. bacterial endocarditis. b. hypertension. c. sick sinus syndrome. d. pericarditis. e. hyperlipidemia. ANS: C
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent fainting, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain. REF: p. 324 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 46. The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to
suspect a. congestive heart failure. b. mitral stenosis. c. endocarditis. d. cardiac tamponade. e. pericarditis. ANS: E
Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy. REF: p. 322 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 47. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms
of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis. e. cardiac tamponade. ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.
REF: p. 320 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 48. Fat deposits in the circulatory system of an older adult can lead to a. diffuse conduction disturbances. b. exaggerated contractility. c. heart failure. d. thinning of the ventricles. e. amyloidosis. ANS: C
Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke. REF: p. 330 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 49. A holosystolic murmur in an infant that is best heard along the left sternal border in the third
to fifth intercostal spaces and does not radiate to the neck is indicative of a. a ventricular septal defect. b. patent ductus arteriosus. c. pulmonary stenosis. d. aortic sclerosis. e. dextrocardia. ANS: A
Regurgitation through the ventricular septal defect results in a holosystolic murmur as described. REF: p. 328 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 50. Ms. S. is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On
auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect a. angina. b. acute rheumatic fever. c. cardiac amyloidosis. d. aortic sclerosis. e. sick sinus syndrome. ANS: B
Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or a skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often the valve becomes stenotic and regurgitant. Prevention is adequate treatment of streptococcal pharyngitis or skin infections. The other possible answers do not have the presenting manifestations and occur mostly in older adults. REF: p. 330 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 51. A grade IV mitral regurgitation murmur would
a. b. c. d. e.
be described as a diastolic murmur. not be expected to have a thrill. radiate to the axilla. be heard best at the base. radiate to the neck.
ANS: C
A grade IV murmur would have a thrill, and a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla. REF: p. 331 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 52. The most helpful finding in determining left-sided heart failure is a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S4 heart sound. e. tachycardia. ANS: C
Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable. REF: p. 321 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 53. Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting,
and is often associated with focal tenderness is most likely a. cardiac. b. pleural. c. esophageal. d. musculoskeletal. e. psychoneurotic. ANS: D
The description given is a classic example of musculoskeletal chest pain. REF: p. 302 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
Chapter 15: Blood Vessels Test Bank—Medical MULTIPLE CHOICE 1. The structure that carries oxygenated blood to the body from the left ventricle is the a. aorta. b. pulmonary artery. c. pulmonary vein. d. superior vena cava. e. inferior vena cava. ANS: A
The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior and inferior venae cavae carry blood from the upper and lower body to the right atrium. REF: p. 332 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 2. The arterial pulse is produced by a. atrial contraction. b. ventricular systole. c. peripheral vascular resistance. d. diastolic pressure. e. atrial relaxation. ANS: B
Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is the function of peripheral vascular resistance. REF: p. 336 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 3. The characteristics of arterial pulses are directly affected by all of the following except a. the volume of blood ejected. b. peripheral arterial resistance. c. venous valvular competence. d. blood viscosity. e. distensibility of aorta. ANS: C
Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.
REF: p. 336 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 4. The level at which the jugular venous pulse is visible gives an indication of a. mitral valve efficiency. b. aortic valve efficiency. c. stroke volume. d. left ventricular pressure. e. right atrial pressure. ANS: E
The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart. REF: p. 336 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 5. The most prominent component of the jugular venous pulse is the a. a wave. b. c wave. c. v wave. d. x slope. e. y slope. ANS: A
The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction. REF: p. 336 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 6. In newborn infants, closure of the ductus arteriosus usually occurs a. before the initiation of labor. b. 12 to 14 hours after birth. c. after 7 days of life. d. between the second and third month. e. during the toddler period. ANS: B
The ductus arteriosus closes usually within the first 12 to 14 hours of life. REF: p. 337 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 7. Blood pressure normally decreases during what period? a. Fertilization b. First trimester of pregnancy c. Second trimester of pregnancy d. Third trimester of pregnancy e. During labor and delivery
ANS: B
Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the patient is lying in the supine position. REF: p. 337 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 8. During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of
the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings a. are usual conditions during pregnancy. b. indicate a need for hospitalization. c. indicate the need for amniocentesis. d. suggest that she is having twins. e. suggest that she never lie on her side. ANS: A
Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. The occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symptoms. REF: p. 337 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 9. Vascular changes expected in older adults include a. loss of vessel elasticity. b. decreased peripheral resistance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. e. increased vasomotor tone. ANS: A
With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure. REF: p. 337 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 10. The amplitude of pulses is recorded on a(n) a. Likert scale of absent to bounding. b. numerical scale of 0 to 4. c. alphabetic scale of A to E. d. descriptive scale of mild, moderate, and severe. e. graded scale of I to VI. ANS: B
The amplitude of pulses is recorded on a numeric scale of 0 to 4: 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding. REF: p. 340 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 11. Which of the following statements is true regarding the examination of peripheral arteries? a. The thumb should never be used to assess pulses. b. Palpate at least one pulse in each extremity, usually the most proximal one. c. The pulses are most readily felt over arteries that lie over bones. d. Extremity pulses do not normally generate waveforms. e. The pads of the fourth and fifth digits of the examiner’s hands are the most
sensitive. ANS: C
The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform). REF: p. 338 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 12. Which arterial pulse is most useful in evaluating heart activity? a. Femoral b. Radial c. Temporal d. Brachial e. Carotid ANS: E
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity. REF: p. 338 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 13. A pulsation that is diminished to the point of being barely palpable would be graded as a. 0. b. 1. c. 2. d. 3. e. 4. ANS: B
A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4. REF: p. 340 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 14. The term claudication refers to
a. b. c. d. e.
pain from muscle ischemia. lack of palpable pulsations. visible extremity changes of arterial occlusion. numbness and tingling in toes and fingers. constriction or narrowing of a vessel.
ANS: A
Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. REF: p. 340 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 15. Conduction system impairment should be suspected if an irregular heartbeat is a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding. ANS: C
A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration. REF: p. 340 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 16. In which location would carotid bruits best be heard? a. Posterior cervical triangle b. Anterior margin of the sternocleidomastoid muscle c. Over the aortic valve d. At the angle of the mandible e. Just anterior to the ear ANS: B
Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. REF: p. 342 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 17. You are examining Mr. S., a 79-year-old man with diabetes who is complaining of
claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency? a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of extremity in contrast to other body parts d. Thin atrophied skin
e. Full superficial veins with rapid filling ANS: D
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling. REF: p. 340 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 18. A sound similar to a murmur that is heard over arteries is a a. thrill. b. hum. c. friction rub. d. bruit. e. heave. ANS: D
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system. REF: p. 340 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 19. In differentiating between an occluded artery or vein, a differentiating sign (present in venous
but not arterial occlusion) is a. color change. b. edema. c. pain with walking. d. pain with palpation. e. paralysis. ANS: B
Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion. REF: p. 344 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 20. To assess a patient’s jugular veins, he or she should first be placed in which position? a. Supine b. Semi-Fowler c. Upright d. Left lateral recumbent e. Leaning forward ANS: A
To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated. REF: p. 342 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 21. Observation of hand veins can facilitate assessment of a. mitral valve competency. b. stoke volume. c. right heart pressure. d. pulse pressure. e. left heart pressure. ANS: C
Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the mid-axillary line (level of the heart) and the level of the collapsed hand veins. REF: p. 343 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 22. You are assessing Mr. Z.’s fluid volume status as a result of heart failure. If your finger
depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as a. 1+. b. 2+. c. 3+. d. 4+. e. 5+. ANS: C
Pitting edema to 6 mm represents a 3+ rating. This edema is noticeably deep and may last more than 1 minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1+) through worse (4+). REF: p. 344 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 23. If pitting edema is unilateral, you would suspect occlusion of a a. lymphatic duct. b. major vein. c. surface capillary. d. superficial artery. e. deep artery. ANS: B
If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.
REF: p. 344 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 24. Thrombosis of a leg vein should be suspected if the patient feels calf pain a. after running a short distance. b. on dorsiflexion of the foot. c. on extending a flexed thigh. d. while wearing high-heeled shoes. e. flexing the knee. ANS: B
Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign. REF: p. 344 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 25. Which of the following statements is most accurate in describing hepatic jugular reflux? a. It is an accurate indicator of heart failure. b. It is exaggerated in patients with right heart failure. c. It is normal when patients are sitting up straight. d. It should be absent in older patients with heart failure. e. It never elevates the jugular venous pressure (JVP) in patients without heart
failure. ANS: B
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure. REF: p. 343 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 26. You are performing jugular venous pressure measurement for your patient in heart failure. You
see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to a. record this measurement as less than 9 cm H2O pressure. b. record this measurement as more than 9 cm H2O pressure. c. confirm that the pulsations decrease with inspirations. d. confirm that the pulsations increase with inspirations. e. place the patient in the supine position and recheck. ANS: C
Confirmation of assessing venous pressure rather than a carotid wave pulse is necessary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected. REF: p. 343
TOP: Discipline: Pathophysiology
MSC: Organ System: Cardiovascular 27. A bounding pulse in an infant may be associated with a. patent ductus arteriosus. b. coarctation of the aorta. c. decreased cardiac output. d. peripheral vaso-occlusion. e. painful, swollen extremities. ANS: A
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion. REF: p. 345 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 28. In infants or small children, a capillary refill time of 4 seconds a. is normal. b. indicates hypervolemia. c. indicates dehydration or hypovolemic shock. d. indicates renal artery stenosis. e. indicates venous occlusion. ANS: C
Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill will be greater than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration. REF: p. 345 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 29. A venous hum heard over the internal jugular vein of a child a. usually signifies untreatable illness. b. usually has no pathologic significance. c. usually requires surgical intervention. d. must be monitored until the child is grown. e. usually indicates dehydration. ANS: B
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. REF: p. 345 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular
30. In pregnancy, blood pressure is lowest a. at conception. b. during the first trimester. c. during the second trimester. d. during the third trimester. e. at the time of delivery. ANS: C
The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels. REF: p. 337 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 31. An idiopathic spasm of arterioles in the digits is called a. arteriosclerosis obliterans. b. giant cell arteritis. c. arteriovenous fistula. d. peripheral arterial aneurysm. e. Raynaud disease. ANS: E
Raynaud phenomenon is an idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries. REF: p. 347 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 32. A major risk factor for arterial embolic disease is a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy. e. constrictive pericarditis. ANS: B
Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. REF: p. 347 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 33. In children, coarctation of the aorta should be suspected if you detect a. a delay between the radial and femoral pulses. b. a simultaneous radial and femoral pulse. c. an absent femoral pulse on the left.
d. bilateral absence of femoral pulses. e. equal blood pressures in the arms and legs. ANS: A
Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. REF: p. 348 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 34. Kawasaki disease is suspected when assessments of a child reveal a. conjunctival injection, strawberry tongue, and edema of the hands and feet. b. conjunctival infection, lymphadenopathy, and a vesicular rash. c. low-grade fever, strawberry tongue, and edema of the hands and feet. d. dermatomal bullae rash, high fever, and cyanotic hands and feet. e. recent streptococcal pharyngitis, vesicular rash, and geographic tongue. ANS: A
Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affecting young males more often than females. Findings may include fever, conjunctival injection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous nonvesicular rashes. REF: p. 349 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular
Chapter 16: Breasts and Axillae Test Bank—Medical MULTIPLE CHOICE 1. What breast structure drains milk from each lobe onto the surface of the nipple? a. Alveolus b. Lactiferous duct c. Montgomery follicle d. Tail of Spence e. Coopers ligament ANS: B
The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple. REF: p. 351
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
2. The largest amount of glandular breast tissue lies in the a. upper inner quadrant. b. lower inner c. tail of Spence. d. upper outer quadrant. e. lower outer. ANS: D
The greatest amount of glandular tissue in the breast lies in the upper outer quadrant. REF: p. 351
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
3. For purposes of examination and communication of physical findings, the breast is divided
into a. halves (upper and lower). b. thirds (left, middle, and right). c. four quadrants plus a tail. d. circles (six consecutive rings, each 1 inch farther away from nipple). e. radial portions 1 through 6. ANS: C
The breast is referenced according to five segments: four quadrants and a tail. REF: p. 351
TOP: Discipline: Gross Anatomy
4. Contraction of breast smooth muscle results in a. benign breast lumps. b. emptying of milk ducts. c. nipple inversion. d. nipple tenderness. e. tension on the suspensory ligaments of Cooper. ANS: B
MSC: Organ System: Reproductive
Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the milk ducts to empty. REF: p. 351
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
5. Montgomery tubercles are most prominent in the breasts of a. men. b. patients with lung disease. c. adolescent girls. d. prepubertal girls. e. pregnant women. ANS: E
Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women. REF: p. 353
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
6. Approximately 75% of women are menstruating by which Tanner stage of breast
development? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5 ANS: D
About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5. REF: p. 352
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
7. During pregnancy, which of the following changes normally occurs in the breasts because of
the effects of luteal and placental hormones? a. The amount of connective tissue increases. b. Epithelial secretory activity decreases. c. Alveoli increase in size and number. d. Vascularization decreases. e. Lactiferous ducts diminish. ANS: C
Breast changes during pregnancy include lactiferous duct proliferation, an increase in alveoli and glandular tissue that displaces connective tissue, and an increase in mammary vascularization. As a result, the breasts are larger, softer, and looser with a blue venous network visible through the skin. REF: p. 353
TOP: Discipline: Physiology
8. Milk production usually begins during which period? a. At conception b. During the first trimester of pregnancy
MSC: Organ System: Reproductive
c. During the second trimester of pregnancy d. At delivery e. 2 to 4 days after delivery ANS: E
Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days. REF: p. 353
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
9. Which breast change is typical after menopause? a. Thickening of the inframammary ridge b. Hypertrophy of glandular tissue c. Increase in number of lactiferous ducts d. Reduction of fat deposits e. Shortening of Cooper’s ligaments ANS: A
After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax. REF: p. 353
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
10. In a woman complaining of a breast lump, it is most important to ask about a. its relationship to menses. b. weight gain. c. sleep patterns. d. immunization status. e. alcohol consumption. ANS: A
Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation. REF: p. 363
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
11. When conducting a clinical breast examination, the examiner should a. forgo the examination if the patient has had a recent mammogram. b. keep the patient covered to respect modesty. c. dim the lights to minimize anxiety. d. inspect both breasts simultaneously. e. begin with palpation of the breasts. ANS: D
Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color. REF: p. 357
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
12. A 50-year-old woman presents as a new patient. Which finding in her personal and social
history would increase her risk profile for developing breast cancer?
a. b. c. d. e.
Drinking three glasses of wine per week Early menopause Nulliparity Late menarche Young age at birth of first child.
ANS: C
Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily. REF: p. 354
TOP: Discipline: Biostatistics
MSC: Organ System: Reproductive
13. If your patient has nipple discharge, you will most likely need a a. Vacutainer tube. b. glass slide and fixative. c. specimen jar with formaldehyde. d. tape strip to test pH. e. needle and syringe. ANS: B
A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose. REF: p. 355
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
14. To begin the clinical breast examination (CBE) for a man, ask him to a. recline on the table with his arms overhead. b. sit with his arms hanging at his sides. c. sit with his hands on his hips. d. stand with his arms clasped behind his back. e. stand leaning forward. ANS: B
Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for both men and women. REF: p. 355
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
15. Inspection of the breasts usually begins with the patient in which position? a. Lateral b. Sitting c. Standing d. Supine e. Prone ANS: B
Inspection begins with the patient in a sitting position with arms hanging loosely at the sides. REF: p. 355
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
16. While examining a 30-year-old woman, you note that one breast is slightly larger than the
other. In response to this finding, you should a. note the finding in the patient’s record. b. ask the patient if she has ever had breast cancer. c. tell the patient to get a mammogram as soon as possible. d. tell the patient to get a mammary sonogram as soon as possible. e. tell the patient to stop caffeine intake. ANS: A
Often one breast is slightly larger than the other. This is a normal variation, and no further intervention is required. REF: p. 365
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
17. Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast
carcinoma? a. Convex or conical shape b. Skin dimpling or retraction c. Pendulous and loose breasts d. Unequal shape or contour e. Lifelong inverted nipple ANS: B
Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development. REF: p. 356
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
18. Venous patterns on breasts are suggestive of pathology when they are a. bilaterally visible. b. seen in obese patients. c. unilateral. d. observed during pregnancy. e. associated with a long-standing unchanging nevus. ANS: C
Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. Nevi that are long-standing, unchanging, or nontender are of little concern. REF: p. 356
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
19. Which of the following is a common benign variation in the breasts of a pregnant woman? a. Unilateral leakage of bloody fluid b. Bilateral leakage of bloody fluid c. Bilateral pronounced venous patterns d. Reddened areas in the tail of Spence e. Peau d’orange appearance ANS: C
Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings. REF: p. 364
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
20. A 23-year-old white woman has come to the clinic because she has missed two menstrual
periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to a. instruct her that this is a side effect of birth control injection therapy. b. suggest pregnancy testing. c. question her use of tanning beds. d. schedule an appointment with a surgeon. e. recommend she remove caffeine from her diet. ANS: B
In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary. REF: p. 364
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
21. In patients with breast cancer, peau d’orange skin is often first evident a. in the axilla. b. in the upper inner quadrant. c. on or around the nipple. d. at the inframammary ridge. e. in the tail of Spence. ANS: C
The areola is the most common initial site to visualize peau d’orange skin. REF: p. 356
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
22. A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a a. normal finding. b. sign of carcinoma. c. skin disease. d. symptom of malnutrition. e. sign of late menarche. ANS: A
Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage. REF: p. 356
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
23. Which of the following is most likely to be a variation of minor consequence? a. Bilateral nipple inversion b. Fixed stonelike nodule c. Serous nipple drainage d. Unequal nipple axis
e. Paget disease of the breast ANS: A
Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue. REF: p. 356
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
24. Recent unilateral inversion of a previously everted nipple suggests a. obesity. b. cancer. c. benign breast disease. d. pregnancy. e. mastitis. ANS: B
Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition. REF: p. 357
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
25. Which condition is more common in African American women than in white women? a. Light areolae b. Nipple inversion c. Retracted areolae d. Supernumerary nipples e. Nipple and areolar colors do not match. ANS: D
The incidence of supernumerary nipples is higher in African American women than in white women. REF: p. 357
TOP: Discipline: Biostatistics
MSC: Organ System: Reproductive
26. When palpating breast tissue, the examiner should use the _____ at each site. a. fingertips b. finger pads c. palms of the hands d. ulnar surface of the hands e. thumbs ANS: B
The finger pads are used for breast palpation because they are more sensitive than the fingertips. REF: p. 361
TOP: Discipline: Physiology
27. Documentation of a breast mass location is a. according to illustration, without a narrative. b. according to clock positions from the nipple. c. measured with calipers from the nipple. d. measured in centimeters from the sternal notch.
MSC: Organ System: Reproductive
e. measured in centimeters from the axilla. ANS: B
Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well. REF: p. 361
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
28. If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-
year-old patient’s breast, you should a. ask the patient if she has a history of breast cancer. b. refer the patient for biopsy. c. ask the patient to have a mammogram as soon as possible. d. record the finding in the patient’s record. e. tell the patient to stop drinking alcohol. ANS: D
The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action. REF: p. 363
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
29. During palpation of a 30-year-old woman’s breast, she complains that the procedure is
painful. You suspect that this may be because she is a. premenstrual. b. a heavy smoker. c. perimenopausal. d. multiparous. e. an alcoholic. ANS: A
Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow. REF: p. 363
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
30. A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination
technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to a. apply an Ace wrap compression bandage for 6 hours a day. b. return for evaluation in 6 months if the problem persists. c. obtain a surgical referral for needle biopsy. d. discontinue all contact sports. e. administer urine screen for illicit drugs. ANS: B
Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.
REF: p. 363
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
31. The tail of Spence extends a. into the midclavicular region. b. toward the supraclavicular area. c. down into the inframammary ridge. d. into the axillae. e. along the sternal border. ANS: D
The tail of Spence extends from the upper outer breast quadrant into the axillae. REF: p. 351
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
32. To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine
with a. her arms straight alongside her body. b. both arms overhead with her palms upward. c. her hands clasped just above her umbilicus. d. one arm overhead and a pillow under her shoulder. e. both hands pressed against her hips. ANS: D
Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder. REF: p. 360
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
33. Palpation of the nipple is done by a. depressing it behind the areola. b. pressing it against the rib cage. c. pulling it outward and releasing it. d. rolling it in a clockwise motion. e. inverting the nipple. ANS: A
At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination. REF: p. 361
TOP: Discipline: Physiology
34. When examining axillary lymph nodes, the patient’s arm is a. raised full above the head. b. extended at the side. c. pressed against the hip. d. crossed over the chest. e. flexed at the elbow. ANS: E
MSC: Organ System: Reproductive
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla. REF: p. 360
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
35. Lymphatic flow of the breast primarily drains a. inferiorly toward the abdomen. b. laterally toward the corresponding arm. c. radially. d. medially toward the sternum. e. inferomedially toward the xiphoid. ANS: C
Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics. REF: p. 352
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
36. The greatest concern for breast cancer is when you palpate _____ nodes. a. anterior cervical b. subscapular c. brachial d. supraclavicular e. internal mammary ANS: D
The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant. REF: p. 360
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
37. You are performing a clinical breast examination for a 55-year-old woman. While palpating
the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should a. apply lotion to your hands. b. use both hands simultaneously. c. ask the patient to press both palms together. d. ask the patient to lower her shoulder on that side. e. ask the patient to turn her head toward that side. ANS: E
Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa. REF: p. 360
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
38. The mother of a newborn boy tells you that her baby’s breasts are swollen and sometimes look
as if they are leaking milk. It is most appropriate to tell her that the a. enlargement and leaking are caused by maternal hormones and will likely resolve without treatment. b. infant may have a congenital heart defect. c. infant may need genetic testing.
d. infant needs ultrasonography of the breasts to exclude a pathologic cause. e. infant may have mastitis. ANS: A
Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months. REF: p. 363
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
39. Male gynecomastia associated with illicit or prescription drug use can be expected to a. lessen when the body becomes accustomed to the drug. b. resolve after the drug is discontinued. c. leave permanent breast enlargement when the drug is discontinued. d. cause purulent drainage if left untreated. e. lead to an increased risk of breast cancer. ANS: B
Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention. REF: p. 364
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
40. A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic
breasts bilaterally. You should advise the patient to a. massage gently and continue nursing. b. apply warm compresses and stop nursing. c. monitor her temperature and restrict fluids. d. sleep with a bra and wash her breasts with antibacterial soap. e. stop nursing and restrict fluids. ANS: A
This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection. REF: p. 365
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
41. You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are
symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with a. fibroadenoma. b. Paget disease. c. cancer. d. mammary duct ectasia. e. fibrocystic changes. ANS: E
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, welldelineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women. REF: p. 365
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
42. Your patient is a nursing mother who asks you to look at a mole she has under her left breast
at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed a. retention cyst. b. case of Paget disease. c. supernumerary nipple. d. fat necrosis. e. Montgomery tubercle. ANS: C
Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples. REF: p. 357
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
43. The sensitivity of clinical breast exam (CBE) in detecting breast cancer ranges from a. 10% to 20%. b. 20% to 39%. c. 40% to 69%. d. 70% to 89%. e. 88% to 99%. ANS: C
The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography. REF: p. 358
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
Chapter 17: Abdomen Test Bank—Medical MULTIPLE CHOICE 1. A serous membrane that lines the abdominal cavity and forms a protective cover for many
abdominal structures is the a. peritoneum. b. mediastinum. c. linea alba. d. mesentery. e. pleura. ANS: A
The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover. REF: p. 370 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 2. What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. Duodenum b. Ileum c. Jejunum d. Falciform ligament e. Pylorus ANS: A
The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine. REF: p. 372 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 3. Peristalsis of intestinal contents is under the control of a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. e. cerebellum. ANS: C
The movement of food and digestive products is regulated by the autonomic nervous system. REF: p. 372 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 4. The esophagus travels a route from a. anterior to the trachea through the mediastinal cavity. b. lateral to the trachea through the diaphragm. c. left of the trachea through the peritoneum.
d. the anterior trachea through the cardiac orifice. e. behind the trachea through the mediastinal cavity. ANS: E
The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters into the stomach. The esophagus connects the pharynx to the stomach. REF: p. 372 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 5. Which organ is part of the alimentary tract? a. Pancreas b. Stomach c. Gallbladder d. Liver e. Spleen ANS: B
The term alimentary tract refers to the continuous tract from the mouth, esophagus, stomach, small intestine, large intestine, and anus. REF: p. 372 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 6. The superior most part of the stomach is the a. body. b. fundus. c. pylorus. d. cardiac orifice. e. pyloric orifice. ANS: B
The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus. REF: p. 372 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 7. Which of the following is true regarding the stomach? a. It lies in the lower abdominal cavity. b. It secretes gastric lipase that serves to digest protein. c. Very little absorption takes place in the stomach. d. The stomach produces most of the body’s bile. e. Pancreatic enzymes directly enter the stomach. ANS: C
The stomach lies across the upper abdomen, secretes pepsin that digests protein and gastric lipase that emulsifies fats, and has a very small role in the absorption of nutrients. Secretions from the liver and pancreas enter the duodenum. REF: p. 372
TOP: Discipline: Physiology
MSC: Organ System: Gastrointestinal 8. The appendix is an extension of the a. ileum. b. cecum. c. ascending colon. d. transverse colon. e. descending colon. ANS: B
The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum. REF: p. 372 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 9. When palpating the abdomen, you should note whether the liver is enlarged in the a. left upper quadrant. b. midepigastric region. c. periumbilical area. d. right upper quadrant. e. right lower quadrant. ANS: D
The liver is located in the right upper quadrant of the abdomen. REF: p. 372 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 10. One major function of the liver is to a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin. ANS: C
The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body. REF: p. 373 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 11. The majority of nutrient absorption takes place in the a. stomach. b. small intestine. c. cecum. d. transverse colon. e. descending colon. ANS: B
Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function is water reabsorption. REF: p. 372 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 12. The major function of the large intestine is a. water absorption. b. food digestion. c. carbohydrate absorption. d. mucous absorption. e. glycogen breakdown. ANS: A
The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus. REF: p. 372 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 13. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of
the a. b. c. d. e.
spleen. kidney. liver. pancreas. gallbladder.
ANS: C
The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea. REF: p. 373 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 14. Contraction of the gallbladder propels bile into the a. stomach. b. duodenum. c. jejunum. d. ileum. e. cecum. ANS: B
With contraction of the gallbladder, bile is excreted into the duodenum. REF: p. 373 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 15. Which abdominal organs also produce hormones and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder
c. Stomach and spleen d. Gallbladder and pancreas e. Pancreas and kidney ANS: E
The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin. REF: p. 373 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 16. Which organ(s) are located in the retroperitoneal space? a. Kidneys b. Lungs c. Spleen d. Gallbladder e. Liver ANS: A
The kidneys are located in the retroperitoneal space, lying behind the abdominal cavity and beside the abdominal aorta. REF: p. 373 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 17. Mrs. G is 7 months’ pregnant and states that she has developed a problem with constipation.
She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as a. decreased movement through the colon and increased water absorption from stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and less nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. e. increased absorption of nutrients and water in the colon. ANS: A
Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy. REF: p. 374 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 18. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is a. decreased hydrochloric acid production. b. increased motility. c. decreased bile absorption. d. decreased motility. e. increased saliva secretion. ANS: D
A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults.
REF: p. 375 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 19. The family history of a patient with diarrhea and abdominal pain should include inquiry about
cystic fibrosis because it a. only affects the GI tract. b. is one cause of malabsorption syndrome. c. is a curable condition with medical intervention. d. is the most frequent cause of diarrhea in general practice. e. is a common genetic disorder. ANS: B
Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns. REF: p. 377 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 20. Infants born weighing less than 1500 g are at higher risk for a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. cystic fibrosis. e. pancreatitis. ANS: B
Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis. REF: p. 377 TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal 21. Inspection of the abdomen should begin with the patient supine and the examiner a. seated on the patient’s right side. b. standing at the foot of the table. c. standing at the patient’s left. d. walking around the table. e. seated on the patient’s left side. ANS: A
This preferred initial position allows tangential viewing of the abdomen for improved assessment of abdominal contour. REF: p. 377 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 22. Before performing an abdominal examination, the examiner should
a. b. c. d. e.
ascertain the patient’s HIV status. have the patient empty his or her bladder. don double gloves. completely disrobe the patient. uncover only the painful areas of the abdomen.
ANS: B
The patient should empty the bladder to ensure an accurate examination of organs as well as to provide comfort for the patient. REF: p. 377 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 23. Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach e. Liver ANS: A
The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus. REF: p. 379 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 24. When examining a patient with tense abdominal musculature, a helpful technique is to have
the patient a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. e. fully extend the legs. ANS: C
To help relax the abdominal musculature, it is helpful to place a small pillow under the patient’s head and under slightly flexed knees. The other choices increase muscle flexion. REF: p. 383 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 25. You ask the patient to raise the head and shoulders while lying in a supine position. A midline
abdominal ridge rises. You chart this observation as a(n) a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. e. incisional hernia. ANS: D
A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity. REF: p. 395 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 26. What condition is associated with striae that remain purplish? a. Cushing disease b. Diastasis recti c. Liver cirrhosis d. Recent pregnancy e. Intraabdominal bleeding ANS: A
Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish. REF: p. 379 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 27. Visible intestinal peristalsis may indicate a. normal digestion. b. intestinal obstruction. c. increased pulse pressure of aorta. d. aortic aneurysm. e. paralytic ileus. ANS: B
Peristalsis is not usually visible and when detected may indicate an intestinal obstruction. REF: p. 381 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 28. After thorough inspection of the abdomen, the next assessment step is to a. percuss. b. palpate nonpainful areas. c. auscultate. d. perform a rectal examination. e. palpate painful areas. ANS: C
Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first. REF: p. 381 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 29. Auscultation of borborygmi is associated with a. gastroenteritis. b. peritonitis.
c. satiety. d. paralytic ileus. e. stenotic arteries. ANS: A
Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as hunger does. Vascular bruits are not associated with borborygmi. REF: p. 381 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 30. Peritonitis often produces bowel sounds that are a. decreased. b. increased. c. high pitched. d. absent. e. accentuated. ANS: A
Decreased bowel sounds occur with peritonitis and paralytic ileus. REF: p. 381 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 31. A patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low-grade
fever attributed to eating some “bad food” 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis? a. Malaise b. Low-grade fever c. Hypoactive bowel sounds d. Soft, rounded abdomen e. Abdominal pain ANS: C
Gastroenteritis is more consistent with findings of crampy abdominal pain, borborygmi, nausea and vomiting, diarrhea, fever, and no abdominal distention. Hypoactive bowel sounds are not expected with gastroenteritis. A firm, distended abdomen suggests an obstruction. REF: p. 381 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 32. An examiner can recognize a friction rub in the liver by a sound that is a. clicking, gurgling, and irregular. b. high pitched and associated with respirations. c. loud, prolonged, and gurgling. d. soft, low-pitched, and continuous. e. low pitched, tinkling, and unrelated to respirations. ANS: B
An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations. REF: p. 381 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 33. To correctly document absent bowel sounds, one must listen continuously for a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes. e. 10 minutes. ANS: D
Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. REF: p. 381 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 34. Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the
correct technique for locating the a. descending aorta. b. lower liver border. c. medial border of the spleen. d. upper right kidney ridge. e. stomach. ANS: B
Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border more than 2 to 3 cm signifies hepatomegaly. REF: p. 381 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 35. When auscultating the abdomen, which finding would indicate collateral circulation between
the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Borborygmi e. Venous hum ANS: E
Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds. REF: p. 381 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 36. Percussion of the abdomen begins with establishing a. liver dullness.
b. c. d. e.
spleen dullness. gastric bubble tympany. overall dullness and tympany in all quadrants. bladder fullness.
ANS: D
Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. REF: p. 381 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 37. To assess for liver enlargement in an obese person, you should a. use the hook method. b. test for cutaneous hypersensitivity. c. auscultate using the scratch technique. d. attempt palpation during deep exhalation. e. have the patient lean over at the waist. ANS: C
If the abdomen is obese or distended or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver. Cutaneous hypersensitivity is a sign of peritonitis and does not contribute to determining liver size. REF: p. 386 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 38. An umbilical assessment in the newborn that is of concern is a. a thick cord. b. an umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. e. visible nondistended superficial veins. ANS: C
What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants. REF: p. 394 TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal 39. Failure to pass a meconium stool in the first 24 hours after birth along with abdominal
distention is often the first sign of a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. e. Wilms tumor.
ANS: B
Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. REF: p. 411 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 40. When palpating the aorta, a prominent lateral pulsation suggests a. aortic aneurysm. b. normal pulsation. c. renal artery fistula. d. vena cava varicosity. e. coarctation. ANS: A
Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm. REF: p. 388 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 41. A patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition early in its course? a. Positive psoas sign b. Positive McBurney sign c. History of periumbilical pain d. Rebound tenderness e. Obturator muscle test ANS: E
Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess. REF: p. 393 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 42. When using the bimanual technique for palpating the abdomen, you should a. push down with the bottom hand and the other atop. b. push down with the top hand and the other atop. c. place hands side by side and push equally. d. place one hand anteriorly and the other posteriorly squeezing the hands together. e. make a fist with the top hand and strike the bottom hand. ANS: B
The bimanual technique uses one hand on top of the other with the top hand pushing down while the bottom hand against the abdomen is used for sensing. REF: p. 394 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal
43. A 23-year-old man comes to the urgent care clinic with intense left flank and lower left
quadrant pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is a. “My urine has been bright yellow.” b. “I have had fever and chills for 2 days.” c. “I also have a headache and neck ache.” d. “My left testicle and shoulder hurt as well.” e. “I have had flatulence and foul-smelling urine.” ANS: D
Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder). REF: p. 391 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 44. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most
associated with a. peptic ulcer disease. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. e. diverticulitis. ANS: E
No choice other than diverticulitis has all of these presenting symptoms. REF: p. 390 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 45. A 45-year-old man relates a several-week history of severe intermittent abdominal burning
sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a(n) a. elevated white blood cell count. b. decreased potassium level. c. positive Helicobacter pylori result. d. increased urine specific gravity. e. folate deficiency. ANS: C
The patient’s presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori. REF: p. 401 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 46. A 51-year-old woman calls with concerns of weight loss and constipation. She reports
enlarged hemorrhoids and rectal bleeding. You advise her to a. use topical over-the-counter hemorrhoid treatment for 1 week. b. exercise and eat more fiber. c. come to the laboratory for a stool guaiac test. d. eat six small meals a day.
e. go to the emergency department for a barium enema. ANS: C
Blood in the stools is an abnormal finding that should never be ignored even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years. REF: p. 404 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 47. Patients presenting with ascites, jaundice, cutaneous spider veins, and nonpalpable liver
exhibit signs of a. cholecystitis. b. pancreatitis. c. inflammatory bowel disease. d. diverticulitis. e. cirrhosis. ANS: E
Jaundice is a result of excessive bilirubin that can result from cholecystitis, pancreatitis, or liver problems. Cirrhosis presents with additional symptoms of ascites, cutaneous spider veins, and a nonpalpable liver as scarring progresses. REF: p. 404 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 48. A patient presents to the emergency department after a motor vehicle accident. The patient
sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured? a. Gallbladder b. Liver c. Spleen d. Stomach e. Colon ANS: C
Spleen laceration or rupture is always suspected with abdominal injury because of its anatomic location. The patient’s presenting symptoms confirm this suspicion. REF: p. 407 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 49. Costovertebral angle tenderness should be assessed whenever you suspect the patient may
have a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception. ANS: C
Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.
REF: p. 408 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 50. Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the
ureter. What condition will be documented in this patient’s health record? a. Glomerulonephritis b. Hydronephrosis c. Pyelonephritis d. Renal abscess e. Renal artery emboli ANS: B
Hydronephrosis is the dilation of the renal pelvis from back pressure of urine that cannot flow past an obstruction in the ureter. REF: p. 408 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 51. The most common congenital anomaly of the gastrointestinal tract is a. biliary atresia. b. meconium ileus. c. intussusception. d. Meckel diverticulum. e. pyloric stenosis. ANS: D
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. REF: p. 412 TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal 52. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A
sausage-shaped mass is palpable in his right upper quadrant. Joe’s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe’s symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis e. Necrotizing enterocolitis ANS: A
Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age. REF: p. 410 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
53. A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she
fastens the child’s diaper. Nephroblastoma is likely for this child when your physical examination of the abdomen reveals a(n) a. fixed mass palpated in the hypogastric area. b. tender, midline abdominal mass. c. olive-sized mass of the right upper quadrant. d. nontender, slightly moveable, flank mass. e. sausage-shaped mass in the left upper quadrant. ANS: D
A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension; fever; malaise; and a firm, nontender mass deep within the flank that is only slightly movable and is usually unilateral. REF: p. 413 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 54. A 1-month-old boy has been vomiting for 2 weeks. How is this symptom of gastroesophageal
reflux disease (GERD) and pyloric stenosis further differentiated in this child’s assessment? a. Vomiting becomes projectile with GERD. b. The infant has regurgitation with pyloric stenosis. c. An olive-sized mass of the right upper quadrant (RUQ) occurs with GERD. d. Normal stools are expected with pyloric stenosis. e. The fontanel becomes sunken with pyloric stenosis. ANS: B
With pyloric stenosis, vomiting becomes projectile, and a small olive-sized mass is palpable in the RUQ; the infant is usually hungry again soon after vomiting, and because little or no food is reaching the intestines, the infant has fewer, smaller stools. The child fails to thrive and has signs of dehydration. These signs are not associated with GERD. Regurgitation can be present with either disease. REF: p. 410 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 55. Urinary incontinence that occurs from the inability to hold urine when the stimulus to urinate
is perceived is called _____ incontinence. a. paralytic b. urge c. overflow d. functional e. stress ANS: B
Urge incontinence is the inability to delay urination when the urge to void occurs. REF: p. 415 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 56. In older adults, overflow fecal incontinence is commonly caused by a. malabsorption. b. parasitic diarrhea.
c. Meckel diverticulum. d. fistula formation. e. fecal impaction. ANS: E
Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool. REF: p. 415 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
Chapter 18: Female Genitalia Test Bank—Medical MULTIPLE CHOICE 1. Posteriorly, the labia minora meet as two ridges that fuse to form the a. fourchette. b. vulva. c. clitoris. d. perineum. e. perineal body. ANS: A
The labia minora join posteriorly at a junction called the fourchette. REF: p. 417
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
2. What structures are located at the 5 o’clock and the 7 o’clock positions of the vaginal orifice
and open onto the sides of the vestibule in the groove between the labia minora and the hymen? a. Skene glands b. Perineal bodies c. Labia majora d. Bartholin glands e. Labia minora ANS: D
Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule. REF: p. 417
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
3. During sexual excitement, how is the vaginal introitus lubricated? a. Bartholin glands secrete mucus. b. Clitoris produces moisture. c. Skene glands secrete fluid. d. Urethral surfaces secrete water. e. Hymen secretes mucus. ANS: A
The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation. REF: p. 417
TOP: Discipline: Physiology
4. The opening of the cervix is referred to as the a. introitus. b. pouch of Douglas. c. cervical isthmus. d. cervical os. e. anterior fornix.
MSC: Organ System: Reproductive
ANS: D
The uterus opens into the vagina at the cervical os. REF: p. 419
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
5. The vaginal mucosa of a woman of childbearing years should appear a. transversely rugated. b. moist and excoriated. c. dry and papular. d. smooth and pink. e. moist with vertical ridges. ANS: A
Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation. REF: p. 418
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
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. round ligaments and ovaries. e. vagina and fundus. ANS: B
The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus. REF: p. 419
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
7. During ovulation, the cervical mucus becomes more a. scant. b. bloody. c. yellow. d. stringy. e. odorous. ANS: D
During ovulation the cervical mucus is increased and is stringy and elastic (spinnbarkeit) REF: p. 421
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
8. The pelvic joint that separates most appreciably during late pregnancy is the a. sacroiliac. b. symphysis pubis c. sacrococcygeal. d. iliofemoral. e. sacrosciatic notch. ANS: B
Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur.
REF: p. 423
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
9. Pregnancy-related cervical changes include a. flattening and lengthening. b. thinning and reddening. c. hardening and pallor. d. shortening and reddening. e. softening and bluish coloring. ANS: E
During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign). REF: p. 423
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
10. The conventional definition of menopause is a. 3 months with no menses. b. 1 year with no menses. c. 6 months of progressively shorter menses. d. 3 consecutive anovulatory cycles. e. the cessation of ovulation. ANS: B
Menopause is defined as 1 year without menses. REF: p. 423
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
11. Which systemic feature is related to the effects of menopause? a. Increased intraabdominal fat deposition b. Decreased LDL levels c. Cold intolerant d. Decreased cholesterol levels e. Decreased risk of cardiovascular disease ANS: A
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes. REF: p. 423
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
12. Which factor is associated with an increased risk of cervical cancer? a. Endometriosis b. Low parity c. HPV vaccination d. High socioeconomic status e. Early parity ANS: E
Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who were not pregnant until they were 25 years or older.
REF: p. 425
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
13. The risk of ovarian cancer is increased by a history of a. low-fat diet. b. cigarette smoking. c. age between 35 and 50 years. d. thin body habitus. e. nulliparity. ANS: E
There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer. REF: p. 425
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
14. The form of gynecologic cancer that is increased in women who have taken tamoxifen is a. vaginal. b. cervical. c. ovarian. d. endometrial. e. perineal skin. ANS: D
Tamoxifen is an antiestrogen drug that acts like an estrogen in the uterus. REF: p. 426
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
15. 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. e. fat intake. ANS: C
Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse. REF: p. 440
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
16. When you enter the examination room of a patient who is scheduled for a pelvic examination,
you note that she seems very anxious. You should a. tell her that there is nothing to be afraid of. b. try to determine the source of anxiety. c. avoid eye contact. d. proceed as though nothing is wrong. e. reschedule for another time.
ANS: B
Most women do not have marked anxiety about a pelvic examination. If your patient does, you will need to find out why she is anxious before proceeding with the examination. REF: p. 427
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
17. The female patient should ideally be in which position for the pelvic examination? a. Fowler b. Prone c. Lateral-supine d. Lithotomy e. Trendelenburg ANS: D
Ideally, position the woman in a lithotomy position for a pelvic examination. REF: p. 426
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
18. During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you
observe for bulging and urinary incontinence, to test for the presence of a. a cystocele. b. a rectocele. c. vaginal prolapse. d. rectal prolapse. e. hymenal remnants. ANS: A
Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele. REF: p. 435
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
19. When you plan to obtain cytologic studies, speculum introduction may be facilitated by a. Valsalva maneuver. b. lubrication with warm water. c. use of plastic speculum. d. opening the blades completely. e. lubrication with gel. ANS: B
It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water. REF: p. 431
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
20. Which of the following findings indicates a possible gonococcal infection? a. Vaginal prolapse b. Discharge from urethra or Skene glands c. Irregular urethral orifice in midline d. Irregular vaginal edges at introitus e. Bulging of anterior or posterior vaginal wall
ANS: B
When milking the Skene glands produces a discharge, it is most commonly a gonococcal infection. REF: p. 441
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
21. When performing a gynecologic exam, the examiner should change gloves after touching the
patient’s a. anal area. b. Bartholin glands. c. Skene glands. d. cervix. e. urethra. ANS: A
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas. REF: p. 430
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
22. During digital examination of the vagina, the cervix is noted to be positioned posteriorly.
Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus. a. retroverted b. anteverted c. midline d. laterally deviated e. retroflexed ANS: B
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus. REF: p. 431
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
23. The presence of cervical motion tenderness may indicate a. pregnancy. b. nulliparity. c. pelvic inflammatory disease. d. vulvovaginitis. e. malignancy. ANS: C
Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions. REF: p. 436
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
24. Which one of the following is a proper technique for use of a speculum during a vaginal
examination? a. Allow the labia to spread; insert the speculum slightly open. b. Press the introitus upward; insert the closed speculum horizontally.
c. Press the introitus downward; insert the closed speculum obliquely. d. Spread the labia; insert the closed speculum horizontally. e. Insert one finger; insert the opened speculum. ANS: C
Gently insert a finger 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 finger obliquely. REF: p. 430
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
25. During a routine vaginal examination, you insert the speculum and visualize the cervix. The
cervix projection into the vaginal vault is approximately 5 cm. Upon bimanual examination, you would expect to find the uterus a. in the midline position. b. in the retroverted position. c. in the anteverted position. d. deviated to the left or right. e. in the retroflexed position. ANS: D
Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position. REF: p. 431
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
26. Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You
should a. chart this as nabothian cysts. b. chart this as a friable cervix. c. obtain a viral culture. d. test the pH of the cervical os. e. chart this as an eroded cervix. ANS: A
This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted. REF: p. 431
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
27. An examiner rotated a brush several times into the cervical os. The brush was withdrawn and
stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection? a. Gonococcal culture b. Cytology smear c. Haemophilus smear d. Trichomonas smear e. Fungal cultures ANS: B
This describes the technique for obtaining a cytology Pap smear. REF: p. 433
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
28. When collecting specimens, which sample should be obtained first? a. Chlamydia swab b. Gonococcal culture c. Pap smear d. Wet mount e. Potassium hydroxide prep ANS: C
A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first. REF: p. 433
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
29. Dacron swabs are necessary when testing for which condition? a. Candidiasis b. Pregnancy c. Trichomonas d. Bacterial vaginosis e. Chlamydia ANS: E
DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cottontipped applicator may interfere with the test results. REF: p. 435
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
30. The visualization of a large proportion of “clue cells” on your wet mount slide examination
suggests a. trichomonal infection. b. bacterial vaginosis. c. candidiasis. d. gonorrhea. e. cervical cancer. ANS: B
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount. REF: p. 435
TOP: Discipline: Microbiology
MSC: Organ System: Reproductive
31. The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide
containing vaginal mucus suggests a. bacterial vaginosis. b. yeast infection. c. chlamydial infection.
d. pregnancy. e. gonorrhea. ANS: A
A positive “whiff test” suggests bacterial vaginosis. REF: p. 435
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
32. A fixed uterus may indicate a. adhesions. b. postmenopause. c. pregnancy. d. premenopause. e. a normal finding. ANS: A
The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions. REF: p. 437
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
33. The assessment of which structure is not part of the bimanual examination? a. Cervix b. Bladder c. Uterus d. Ovaries e. Adnexa ANS: B
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries. REF: p. 435
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
34. The rectovaginal examination is an important component of the total pelvic examination
because it a. is the most direct cervical examination route. b. is a more comfortable examination for the posthysterectomy patient. c. is an alternate source for cytology specimens. d. allows the examiner to reach almost 2.5 cm higher into the pelvis. e. provides better evaluation of the bladder. ANS: D
The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder. REF: p. 438
TOP: Discipline: Physiology
35. Prominent labia minora are a normal finding in a. adolescents. b. menopausal women. c. newborns.
MSC: Organ System: Reproductive
d. pregnant women. e. postmenopausal women. ANS: C
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent. REF: p. 439
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
36. Swollen and bruised genitalia in a newborn are most likely related to a. a breech delivery. b. a congenital defect. c. an infection. d. maternal hormones. e. an enlarged clitoris. ANS: A
Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery. REF: p. 439
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
37. The most common cause of a foul vaginal discharge in children is a(n) a. rectocele. b. foreign body. c. infection. d. ruptured hymen. e. accident. ANS: B
Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body. REF: p. 441
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
38. A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vagina vault, you
should first a. insert a pediatric vaginal speculum. b. place your hand firmly against the labia and spread your fingers. c. insert a cotton-tipped applicator and press down. d. pull the labia anteriorly and slightly to the side. e. place the child prone and in the fetal position. ANS: D
Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver. REF: p. 440
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
39. 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. Upon 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. e. malignancy. 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. REF: p. 441
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
40. When a woman is not sexually active, cervical cancer screening should begin a. at menarche. b. by age 15 years. c. by age 18 years. d. by age 21 years. e. by age 30 years. ANS: D
Women who are not sexually active should have their first examination by the age of 21 years. Women under age 21 should not be tested. REF: p. 437
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
41. Softening of the uterine isthmus occurring between 6 and 8 weeks of pregnancy is the _____
sign. a. Homan b. McDonald c. Piskacek d. Hegar e. Chadwick ANS: D
Between the sixth and eighth weeks of pregnancy, the uterine isthmus softens, which is known as the Hegar sign. REF: p. 443
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
42. Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy. a. 10 b. 16 c. 20 d. 24 e. 30 ANS: C
At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.
REF: p. 443
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
43. During a pelvic examination for a postmenopausal woman, you would expect to assess a. a wider and longer vaginal vault. b. absence of vaginal wall rugation. c. a nonpalpable cervical os. d. a more mobile cervix. e. palpable ovaries. ANS: B
Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy. REF: p. 423
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
44. What accommodations should be used in the position of a hearing-impaired woman for a
pelvic examination? a. The patient should assume the “M” or “V” position. b. The patient should be in the diamond-shaped position. c. The head of the table should be elevated. d. The lithotomy position with obstetric stirrups should be used. e. The patient should be in the knee–chest position. ANS: C
The woman with a hearing impairment will need to see the clinician or an interpreter during the examination; therefore, her head should be elevated. REF: p. 449
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
45. Asking the woman to close the introitus during a pelvic examination is a test for a. endometriosis. b. rectocele. c. cervical polyps. d. muscle tone. e. cystocele. ANS: D
Test for muscle 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. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing. REF: p. 430
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
46. Which of the following is a normal component of physiologic vaginitis seen on a wet mount? a. Three to five white blood cells (WBCs) b. Clue cells c. Branching hyphae d. Spores e. Motile flagellates
ANS: A
Up to three to five WBCs on a wet mount are within normal limits. REF: p. 457
TOP: Discipline: Microbiology
MSC: Organ System: Reproductive
47. The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is a. homogeneous and gray with a low pH. b. scant and curdy with a low pH. c. profuse and frothy with a high pH. d. profuse and curdy with a low pH. e. bloody and thin with a high pH. ANS: C
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5). REF: p. 457
TOP: Discipline: Microbiology
MSC: Organ System: Reproductive
48. 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 or 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 is 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. e. diagnose ovarian cyst and schedule follow-up. ANS: B
The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test. REF: p. 461
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
49. A cervical polyp usually appears as a a. grainy appearance 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. e. flesh-colored, firm protrusion at the cervical os. ANS: B
Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical canal. REF: p. 431
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
50. Mittelschmerz may occur in which phase of the menstrual cycle? a. Menstrual b. Postmenstrual c. Ovulation
d. Secretory e. Luteal ANS: C
Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month REF: p. 437
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
Chapter 19: Male Genitalia Test Bank—Medical MULTIPLE CHOICE 1. The movement of the testes by cremasteric muscular action regulates a. ejaculatory flow. b. sebaceous material production. c. testicular temperature. d. urinary flow. e. prostate gland secretion. ANS: C
The cremasteric muscle contracts and relaxes the scrotum. This action alters the distance of the testes from the body to cool or warm the testes. REF: p. 466
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
2. What structure of the male genitalia travels through the inguinal canal and unites with the
seminal vesicle to form the ejaculatory duct? a. Epididymis b. Corpus cavernosum c. Urethra d. Vas deferens e. Ureter ANS: D
The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct. REF: p. 468
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
3. Normally, the male urethral orifice is located a. 2 mm ventral to the tip of the glans. b. on the dorsal surface of the glans. c. cephalad to the dorsal vein. d. adjacent to the prostate. e. on the ventral surface of the corpus spongiosum. ANS: A
The urethral orifice is located approximately 2 mm ventral to the tip of the glans. REF: p. 466
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
4. While examining an 18-year-old man, you note that the penis and testicles are more darkly
pigmented than the body skin. You should consider this finding to be a. caused by a lack of testosterone. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone.
e. within normal limits. ANS: E
Darker pigmentation from other body skin is a normal finding on the penis and testicles. REF: p. 466
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
5. Testicular temperature must be maintained lower than 37° C for which of the following to
occur? a. Penile erection b. Spermatogenesis c. Testosterone production d. Ejaculatory duct to function e. Sperm to ascend in the vas deferens ANS: B
The production of sperm is dependent on the maintenance of temperatures below normal body temperature of 37° C or 98.6° F. REF: p. 466
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
6. In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is
usually a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes. e. evidence of a gonococcal infection. ANS: B
The glans secretes a sebaceous material, smegma, in uncircumcised males. It looks like a cheesy white material. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. Smegma is not candidiasis nor is it suggestive of diabetes, cancer, or gonorrhea. REF: p. 466
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
7. The greatest contribution to the volume of ejaculate comes from the a. prostate. b. epididymis. c. seminal vesicles. d. corpus cavernosa. e. testes. ANS: A
The major volume of ejaculatory fluid comes from the prostate gland. REF: p. 468
TOP: Discipline: Physiology
8. Inspection of the scrotum should reveal a. no epidermoid cysts. b. two testes per sac.
MSC: Organ System: Reproductive
c. smooth scrotal sacs. d. left scrotal sac lower than the right. e. lightly pigmented skin. ANS: D
The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The scrotum is more darkly pigmented, has one testis per sac, and has small epidermoid cysts that give it a lumpy appearance. REF: p. 472
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
9. Sexual differentiation in the fetus has occurred by _____ weeks’ gestation. a. 8 b. 12 c. 16 d. 20 e. 30 ANS: B
By 12 weeks’ gestation, sexual differentiation has occurred in the fetus. REF: p. 468
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
10. How much blood usually engorges the two corpora cavernosa of the penis when it is erect? a. 5 to 15 mL b. 20 to 50 mL c. 60 to 80 mL d. 70 to 90 mL e. Over 100 mL ANS: B
Penile erection occurs when 20 to 50 mL of blood is contained in the corpora cavernosa. REF: p. 468
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
11. Expected genitalia changes that occur as men age include a. that ejaculatory volume decreases with age. b. that erections develop more quickly. c. that the viability of sperm increases. d. that the scrotum becomes more pendulous. e. an increase in time for mature sperm to develop. ANS: D
Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production. REF: p. 468
TOP: Discipline: Physiology
12. Parents of a 6-year-old boy should be asked if he has a. erections. b. nocturnal emissions.
MSC: Organ System: Reproductive
c. rapid detumescence. d. scrotal swelling. e. a more pendulous scrotum. ANS: D
Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The question of nocturnal emissions is asked of adolescents; erections and rapid detumescence questions are questions for older men. With the onset of puberty, the scrotum becomes more pendulous. REF: p. 469
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
13. Which of the following is a risk factor for testicular cancer? a. Circumcision b. Condyloma acuminatum c. Cryptorchidism d. Poor hygiene e. Multiple sexual partners ANS: C
Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer. REF: p. 470
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
14. Gloves are used for examination of male genitalia to a. facilitate grasp of external organs. b. make masses easier to detect. c. prevent spread of unsuspected infection. d. protect the patient from embarrassment. e. decrease the incidence of erections. ANS: C
Inspection of male genitalia involves manipulation of the glans and scrotum. This potentially involves contact with body secretions and infections; therefore, gloves are required. REF: p. 471
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
15. 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 thumb and forefinger. d. transilluminate the penile shaft. e. apply a lubricant to the meatus. ANS: C
Inspection of the urethral orifice is accomplished by pressing the glans between the examiner’s thumb and forefinger. This maneuver opens the slitlike orifice for further inspection. REF: p. 472
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
16. Which penile structure should be visible to inspection during the physical examination? a. Cowper glands b. Proximal urethral c. Epididymis d. Corpus cavernosa e. Dorsal vein ANS: E
The dorsal vein of the penis should be evident. The others are internal structures. REF: p. 471
TOP: Discipline: Gross Anatomy
MSC: Organ System: Reproductive
17. You are inspecting the genitalia of an uncircumcised man. 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. e. chart the finding as balanitis. ANS: B
This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. Balanitis is inflammation of the glans that may occur with phimosis. REF: p. 471
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
18. Which technique is appropriate to detect an inguinal hernia? a. Conduct percussion while the patient coughs. b. Have the patient strain as you pinch the testes. c. Inspect rectal areas as the patient bears down. d. Conduct the examination only in the supine position. e. Move your finger upward along the vas deferens. ANS: E
Examination for inguinal hernias is performed with the patient standing. Inspect the groin while the patient performs a Valsalva maneuver. Insert your examination finger into the lower part of the scrotum and follow upward along the vas deferens to screen for a hernia. REF: p. 473
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
19. Which type of hernia lies within the inguinal canal? a. Umbilical b. Direct c. Indirect d. Femoral e. Incisional ANS: C
Hernias found within the inguinal canal are called indirect hernias.
REF: p. 473
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
20. Which one of the following conditions is of minor consequence on the adult male genitalia? a. A viscus felt medial to the external canal b. Continuous penile erection c. Lumps in scrotal skin d. Venous dilation in spermatic cord e. Adhesions of the foreskin ANS: C
Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. The other choices require medical or surgical intervention. REF: p. 472
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
21. Mr. L. has an unusually thick scrotum with edema and pitting. He has a history of cardiac
problems. The appearance of his scrotum is more likely a(n) a. congenital defect that has worsened. b. indication of general fluid retention. c. normal consequence of aging. d. complication to the development of mumps. e. consequence of prior STDs. ANS: B
General fluid retention can cause scrotal thickening and pitting edema and is more often 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. REF: p. 472
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
22. 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. e. nodularity. 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. Any nodules found on the testes must be evaluated for malignancy and are not characteristic of syphilis or diabetes. REF: p. 473
TOP: Discipline: Pathophysiology
23. A normal vas deferens should feel a. tender. b. smooth. c. rugated. d. spongy. e. beaded.
MSC: Organ System: Reproductive
ANS: B
The vas deferens should normally feel smooth, discrete, and nontender. REF: p. 473
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
24. A premature infant’s scrotum will be a. bifid. b. loose. c. rugated. d. smooth. e. enlarged. ANS: D
A scrotum in a premature infant will appear underdeveloped and smooth without rugae or testes; a full-term infant should have a loose, pendulous scrotum with rugae and a midline raphe. REF: p. 474
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
25. An enlarged, painless testicle in an adolescent or adult may indicate a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle. e. hypospadias. ANS: C
A hard, enlarged, painless testicle can indicate a tumor in an adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. Hypospadias is a congenital defect of the urethral opening causing the meatus to be located ventral to its normal position. REF: p. 475
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
26. You palpate a soft, slightly tender mass in the right scrotum of a man. 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, then compare pain level. d. transilluminate the mass. e. culture the meatus for gonococcal infection. ANS: D
A soft mass is either 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. Urethral cultures are not indicated at this point. REF: p. 475
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
27. The most common cancer in young men age 15 to 30 years is
a. b. c. d. e.
testicular. penile. pancreatic. anal. prostate.
ANS: A
Because testicular tumors are the most common cancer occurring in young adults, selfexamination is encouraged. REF: p. 483
TOP: Discipline: Biostatistics
MSC: Organ System: Reproductive
28. The most emergent cause of testicular pain in a young male is a. varicocele. b. epididymitis. c. tumor. d. hydrocele. e. testicular torsion. ANS: E
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. REF: p. 483
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
29. 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 and fever. Your prioritized assessment 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. e. have the patient stand and observe the scrotum for a “bag of worms.” ANS: C
The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a supporting finding to differentiate torsion from epididymitis. REF: p. 483
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
30. When examining a small child, in which position should he be placed to help push the
testicles into the scrotum? a. Trendelenburg b. Tailor c. Standing d. Prone e. Supine ANS: B
When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination.
REF: p. 475
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
31. The most common type of hernia occurring in young males is a. hiatal. b. incarcerated femoral. c. indirect inguinal. d. umbilical. e. femoral. ANS: C
The most common type of hernia in children and young males is an indirect inguinal hernia. REF: p. 476
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
32. Difficulty replacing the retracted foreskin of the penis to its normal position is called a. paraphimosis. b. Peyronie disease. c. prepuce. d. priapism. e. phimosis. ANS: A
Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans. REF: p. 478
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
33. The finding of a painless indurated lesion on the glans penis is most consistent with a. herpes simplex. b. herpes zoster. c. warts. d. chancre. e. molluscum contagiosum. ANS: D
Syphilitic chancre is a painless lesion with an indurated border and a clear base. REF: p. 478
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
34. A finding associated with male genital herpes is a. disseminated lymphadenopathy. b. pain subsiding with scrotal elevation. c. soft, red papules on the prepuce. d. painful superficial penile vesicles. e. pearly gray, dome-shaped lesions. ANS: D
Genital herpes presents as painful superficial vesicles on an erythemic base. REF: p. 478
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
35. A male whose urethral meatus opens on the ventral surface of his penis has which condition? a. Peyronie disease b. Hydrocele c. Hypospadias d. Normal variation e. Epispadias ANS: C
The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias. REF: p. 484
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
36. Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably a. lymphogranuloma venereum. b. condylomata. c. molluscum contagiosum. d. chancres. e. herpetic lesions. ANS: C
Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum. REF: p. 480
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
37. Self-examination of the male genitalia a. should be restricted to adults with prior cryptorchidism. b. should be performed while bathing. c. starts with palpation and then inspection. d. should be performed yearly. e. cannot be adequately performed due to poor visualization of the scrotum. ANS: B
Monthly self-examination is recommended as a screening test for testicular cancer as well as sexually transmitted infections for all young men starting at 15 years of age. It is encouraged during bathing because the scrotal skin is less thick at this time and because the scrotum hangs looser because of the warmth. Inspection is done first followed by palpation. REF: p. 470
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
38. A 12-year-old boy says that his left scrotum has a soft swollen mass. The scrotum is not
painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with a. orchitis. b. hydrocele. c. rectocele. d. scrotal hernia. e. epididymitis. ANS: B
A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore does transilluminate. 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. Epididymitis is an extremely painful condition. REF: p. 481
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
39. Which condition is a complication of mumps in an adolescent or adult? a. Varicocele b. Epididymitis c. Orchitis d. Paraphimosis e. Cystitis ANS: C
Orchitis is uncommon unless seen as a complication of mumps in an adolescent or adult. REF: p. 482
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
40. A man 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. e. a painless ulceration on the penile shaft. ANS: B
Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection. REF: p. 480
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
41. A cremasteric reflex should result in a. the scrotum appear to contain a “bag of worms.” b. penile deviation to the left side. c. scrotum to elevate bilaterally. d. immediate erection of the penis. e. testicle and scrotal rise on the stroked side. ANS: E
Upon stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should rise on the stroked side. REF: p. 474
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
Chapter 20: Anus, Rectum, and Prostate Test Bank—Medical MULTIPLE CHOICE 1. The adult internal rectal sphincter is controlled by the a. autonomic nervous system. b. central nervous system. c. peripheral nervous system. d. lumbar spinal reflexes. e. sacral spinal reflexes. ANS: A
The internal ring of smooth muscle of the anal canal is under involuntary autonomic control. REF: p. 485 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 2. The urge to defecate is caused by a. constriction of the internal sphincter. b. the rectum filling with feces. c. cognitive processes. d. fluid volume in the stomach. e. relaxation of the external sphincter. ANS: B
The sensation to defecate results from the rectum filling with feces, which, in turn, stimulates relaxation of the internal sphincter. REF: p. 486 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 3. The proximal end of the rectum is continuous with the a. transverse colon. b. duodenum. c. ileum. d. internal rectal sphincter. e. sigmoid colon. ANS: E
Ascending from the anus is the rectum, then the sigmoid colon, which is at the proximal end of the rectum. REF: p. 486 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 4. The mother of a 1-week-old breastfed baby tells you that she is concerned because her baby
has a small bowel movement each time he feeds. You should let the mother know that a. this is normal. b. she should feed the baby less. c. this usually indicates a congenital abnormality.
d. she needs to change the baby to formula. e. the baby’s internal sphincter is underdeveloped. ANS: A
The newborn’s myelination of the spinal cord is incomplete, and both internal and external sphincters are under involuntary reflexive control, that is, the gastrocolic reflex. Therefore, newborns stool after each feeding. REF: p. 486 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 5. In males, which surface of the prostate gland is accessible by digital examination? a. Median lobe b. Posterior c. Superior d. Anterior e. Lateral 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. REF: p. 486 TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary 6. The prostatic sulcus a. divides the prostate into anterior and posterior lobes. b. is the site of the seminal vesicle emergence. c. refers to the anterior aspect of the prostate. d. secretes clear viscous mucus. e. divides the prostate into right and left lateral lobes. ANS: E
The median sulcus divides the two lateral lobes and is palpated as a shallow groove. REF: p. 486 TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary 7. When the practitioner is inquiring about the patient’s lower GI tract history, the inquiry should
include a. bowel habits. b. dietary habits. c. hemorrhoid surgery. d. laxative use. e. recent travel. ANS: C
Past medical history should inquire about hemorrhoids; spinal cord injury; benign prostatic hypertrophy; prostate, colorectal, breast, ovarian, and endometrial cancers; and episiotomies of fourth-degree lacerations during delivery. Habits and travel history are part of personal and social history; the use of laxatives is part of history of present illness.
REF: p. 488 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 8. 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. e. urges to defecate. ANS: A
Older adults experience an elevated pressure threshold for the sensation of rectal distention and therefore are susceptible to constipation. They also experience early satiety, fecal incontinence, and prostate glandular hypertrophy. REF: p. 487 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 9. Which of the following is a risk factor for anal cancer? a. White race b. Diet low in animal fats and proteins c. Physical inactivity d. Infection with high risk HPV e. Low body fat ANS: D
Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not. REF: p. 488 TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal 10. Factors associated with increased risk of prostate cancer include a. African American descent. b. cigarette smoking. c. low-fat diet. d. alcoholism. e. obesity. ANS: A
The incidence rate of prostate cancer is higher for African American men compared with white American men. African American men also have a higher mortality rate from prostate cancer. REF: p. 488 TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary 11. Caliber of urinary stream is routine information in the history of a. adolescents. b. infants. c. older men. d. sexually active men.
e. pregnant women. ANS: C
Routine questions about the caliber of urinary stream and dribbling are directed toward older men because hypertrophy of the prostate gradually impedes urine flow. REF: p. 489 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 12. Equipment for examination of the anus, rectum, and prostate routinely includes gloves and a. an anoscope. b. lubricant and penlight. c. slides and normal saline. d. swabs and culture medium. e. a hand mirror and gauze. ANS: B
Equipment for the examination includes penlight, lubricating jelly, gloves, and fecal occult blood testing materials. REF: p. 489 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 13. When performing a rectal examination in a man, in which position is the patient generally
placed? a. Lithotomy b. Prone c. Trendelenburg d. Left lateral e. Supine ANS: D
Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area. REF: p. 489 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 14. Which of the following conditions is most commonly seen in adults with diabetes? a. Pinworms b. Pilonidal cysts c. Perianal fistula d. Pruritus ani e. Anorectal fissure ANS: D
Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus. REF: p. 489 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal
15. To make visualization of polyps in the anorectal area easier, you should a. apply clear jelly around the anal orifice. b. ask the patient to bear down. c. ask the patient to relax the sphincter. d. rotate your finger inside the anal canal. e. have the patient contract the external sphincter. ANS: B
Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible. REF: p. 489 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 16. Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience a. bulging and wrinkling. b. constipation and pallor. c. urinary symptoms. d. tenderness and inflammation. e. diarrhea and redness. ANS: D
Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani. REF: p. 489 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 17. Palpation of the anal ring is done by a. bidigital palpation with 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. e. rotation of the forefinger outside the anus. ANS: D
The anal muscular ring is palpated by rotating the examination finger. A bidigital palpation with your thumb against the perianal tissue helps assess the bulbourethral glands. REF: p. 489 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 18. The initial digital approach to the rectal examination should be a. at a right angle to the anus. b. with direct horizontal pressure of fingertip. c. with the finger pad pressed against anal verge. d. during sphincter tightening. e. bidigital palpation with thumbs. ANS: A
The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted. REF: p. 490 TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal 19. A healthy prostate protrudes into the rectal wall a distance of _____ cm. a. less than 1 b. 1 to 2 c. 2 to 3 d. 3 to 4 e. more than 4 ANS: A
A healthy prostate should not protrude more than 1 cm into the rectum. REF: p. 491 TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary 20. The posterior surface of the prostate can be located by palpation of the a. posterior wall of the rectum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. e. anal canal and perineum. ANS: B
Palpation of the rectal anterior wall facilitates posterior prostate location. REF: p. 491 TOP: Discipline: Gross Anatomy MSC: Organ System: Renal/Urinary 21. The cervix may normally be palpated through the a. anterior rectal wall. b. left lateral rectal wall. c. right lateral rectal wall. d. posterior uterine surface. e. posterior rectal wall. ANS: A
In women, the cervix can be palpated through the anterior rectal wall. It feels like a small, round mass. REF: p. 491 TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal 22. Your patient’s chief complaint is repeated pencil-like stools. Further examination should
include a. stool culture. b. parasite testing. c. digital rectal examination (DRE).
d. prostate examination. e. cellulose tape test. ANS: C
Persistent pencil-shaped stools are indicative of stenosis from scarring or pressures from a mass. DRE should be performed to assess for a mass. REF: p. 492 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 23. Very light tan or gray stool may indicate a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding. ANS: B
Very light tan or gray stools suggest obstructive jaundice. REF: p. 491 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 24. Tarry black stool should make you suspect a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. e. lower intestinal bleeding. ANS: C
Upper intestinal tract bleeding results in tarry black stools. REF: p. 491 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 25. Prostate-specific antigen (PSA) screening is controversial because a. there are few false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. there are associated harms of false-positive test results. e. it detects prostate cancer only in its late stage. ANS: D
The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results, unnecessary biopsies, and overdiagnosis. REF: p. 491 TOP: Discipline: Biostatistics MSC: Organ System: Renal/Urinary 26. An infant with constipation and a consistently empty rectum may need evaluation for
a. b. c. d. e.
sexual abuse. Hirschsprung disease. pilonidal cyst. intestinal parasites. rectal abscess.
ANS: B
A consistently empty rectum in the presence of constipation is a clue to the diagnosis of Hirschsprung disease. Other presentations include the failure to pass meconium in the first 24 hours coupled with a gradual onset of abdominal distention and vomiting. REF: p. 493 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 27. A lower spinal cord lesion may be indicated by which finding? a. Lack of an “anal wink” b. Anorectal fissure c. Anal fistula d. Passage of meconium e. Small flaps of anal skin ANS: A
Lightly touching the anal opening of an infant should produce a contraction referred to as the “anal wink.” A negative wink may indicate a lower spinal cord lesion. REF: p. 492
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
28. Pinworms and Candida may both cause a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation. ANS: C
Pinworms and Candida both cause perirectal irritation and itch. REF: p. 492 TOP: Discipline: Microbiology MSC: Organ System: Gastrointestinal 29. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal.
When is it likely that her closed anal passageway will be suspected by her health care providers? a. After she develops a scaphoid abdomen b. During her first feeding when she vomits c. When she bleeds from the rectum d. When she fails to pass meconium stool e. When the rectum prolapses ANS: D
Anal patency of the newborn is confirmed by passage of meconium stool.
REF: p. 499 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 30. A common cause of dark green or black stool color during pregnancy is indicative of a. consumption of iron preparations. b. consumption of vitamins. c. intestinal parasites. d. slow bleeding of hemorrhoids. e. slow intestinal bleeding. ANS: A
The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools. REF: p. 493 TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal 31. An expected anal or rectal finding late in pregnancy is the presence of a. cysts. b. rectal prolapse. c. skin tags. d. polyps. e. hemorrhoids. ANS: E
Hemorrhoids are an expected variation late in pregnancy. REF: p. 493
TOP: Discipline: Pathophysiology
MSC: Organ System: Reproductive
32. Thrombosed hemorrhoids are a. flabby skin sacs. b. red, inflamed, and painful. c. fluctuant soft papules. d. blue, shiny painful masses. e. pink to whitish. ANS: D
Thrombosed hemorrhoids appear as blue, shiny masses at the anus; they contain clotted blood and are edematous and painful. Flabby skin sacs describe a resolved hemorrhoid; red, inflamed, painful, and fluctuant describe a rectal abscess. Pink to whitish growths that occur on the anus describe the findings consistent with anal warts. REF: p. 496 TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal 33. Palpation of a normal prostate in an older adult is likely to feel a. cool. b. grainy. c. polypoid. d. rubbery. e. hard.
ANS: D
Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric. REF: p. 498 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 34. Prostate examination findings of a hard, irregular, painless nodule with obliteration of the
median sulcus are signs of a. benign prostatic hypertrophy. b. cancer of the prostate. c. longstanding prostatitis. d. swelling caused by aging. e. acute prostatitis. ANS: B
Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth. REF: p. 499 TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary 35. Cellulose tape test is used for the detection of a. imperforate anus. b. condyloma. c. anal fissure. d. steatorrhea. e. enterobiasis. ANS: E
Pinworms are collected by applying tape to the perianal folds and then pressing the tape on a glass slide. REF: p. 500 TOP: Discipline: Microbiology MSC: Organ System: Gastrointestinal
Chapter 21: Musculoskeletal System Test Bank—Medical MULTIPLE CHOICE 1. Fluid that lubricates articular cavities is called a. blood. b. synovial fluid. c. mucus. d. cerumen. e. marrow. ANS: B
Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. REF: p. 501 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 2. Bones around a joint are held together by a. synovial membranes. b. ligaments. c. muscles. d. cartilage. e. tendons. ANS: B
Bones are held together within a joint by ligaments. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber. REF: p. 501 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 3. Bones are attached to muscles by a. synovial membranes. b. ligaments. c. muscles. d. cartilage. e. tendons. ANS: E
Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts as an insulator for bones in joints. REF: p. 501 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
4. The elbow joint that allows for flexion and extension in one plane represents a type of _____
joint. a. articulated b. ball and socket c. hinge d. pivot condyloid e. saddle ANS: C
A hinge joint allows for flexion and extension in one plane. A condyloid joint allows flexion and extension in two planes. A ball and socket joint allows movement in all planes. An articulated joint means simply that the joint allows movement. A saddle joint allows motion in two planes at right angles to each other but no axial rotation. REF: p. 505 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 5. Spinal vertebrae are separated from each other by a. bursae. b. tendons. c. disks d. ligaments. e. synovial fluid. ANS: C
Except for sacral vertebrae, the spinal vertebrae are separated from one another by fibrocartilaginous disks. REF: p. 505 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 6. The glenohumeral joint is the other name for the a. elbow. b. hip. c. wrist. d. scapula. e. shoulder. ANS: E
The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and the scapula. REF: p. 505 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 7. The joint where the humerus, radius, and ulna articulate is the a. wrist. b. elbow. c. shoulder. d. sternum. e. clavicle.
ANS: B
The elbow is the site where the humerus, radius, and ulna meet. The shoulder is made up of the humerus and scapula. The wrist is made up of the radius and the carpal bones of the hand. The sternum connects to the clavicles and ribs. The clavicle connects to the scapula but not the humerus. REF: p. 505 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 8. The articulation of the radius and carpal bones is the a. wrist. b. elbow. c. shoulder. d. clavicle. e. digits. ANS: A
The joint composing the radius and carpal bones is called the wrist. REF: p. 505 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 9. The cruciate ligaments within the knee provide for a. anterior and posterior stability. b. medial and lateral stability. c. movement on one plane. d. pivoting and rotation. e. shock absorption. ANS: A
The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption. REF: p. 507 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 10. Medial and lateral surfaces of the tibiotalar joint are protected by a. bursae. b. tendons. c. muscles. d. ligaments. e. synovial fluid. ANS: D
The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle. REF: p. 507 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal
11. The suprapatellar bursa separates the patella, quadriceps tendon, and muscle from the a. talus. b. fibula. c. femur. d. pelvis. e. tibia. ANS: C
The suprapatellar bursa separates the knee, the quadriceps, and muscle from the femur. REF: p. 507 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 12. The tibia, fibula, and talus articulate to form the a. ankle. b. knee. c. hip. d. pelvis. e. forefoot. ANS: A
The tibia, fibula, and talus, or heel, join to form the ankle. REF: p. 507 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 13. Long bones in children have growth plates known as a. epiphyses. b. epicondyles. c. synovium. d. fossae. e. diastasis. ANS: A
Epiphyses are the growth plates found in long bones in children. REF: p. 508 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 14. Ligaments are stronger than bone until a. birth. b. infancy. c. adolescence. d. middle adulthood. e. old age. ANS: C
Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger. REF: p. 508 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal
15. Injuries to long bones and joints are more likely to result in fractures than in sprains until a. preschool age. b. school age. c. adolescence. d. early adulthood. e. middle adulthood. ANS: C
Fractures to long bones and joints are more common during growth years. During childhood and early adolescence, the epiphyseal growth plates are more easily injured than are the tougher ligaments. Growth is completed with the closure of the epiphyseal growth plates at about 20 years of age. REF: p. 508 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 16. The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are caused
by a. b. c. d. e.
decreased mineral deposition. increased hormone secretion. uterine enlargement. gait changes. increased mineral resorption.
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. REF: p. 508 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 17. Skeletal changes in older adults are the result of a. increased bone deposition. b. increased bone resorption. c. tendons becoming more elastic. d. decreased bone deposition. e. decreased bone resorption. ANS: B
As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults. REF: p. 508 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 18. The usual number of vertebrae is a. 23. b. 24. c. 25. d. 26.
e. 27. ANS: B
The number of vertebrae that is most common is 24; as few as 11% of persons have 23, and almost 5% have 26. REF: p. 504 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 19. 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. e. poor physical conditioning. 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, or hypercalciuria. REF: p. 509 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 20. Risk factors for sports-related injuries include a. competing in colder climates. b. previous fractures. c. history of recent weight loss. d. failure to warm up before activity. e. light body frame. 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. A light body frame is a risk factor for osteoporosis, not sports-related injuries. REF: p. 539 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 21. Light skin and thin body habitus are risk factors for a. rheumatoid arthritis. b. osteoarthritis. c. congenital bony defects. d. osteoporosis. e. sports-related injuries. ANS: D
People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, bony defects, and sports-related injuries are not found to have a correlation with light skin and a small frame. REF: p. 510
TOP: Discipline: Biostatistics
MSC: Organ System: Musculoskeletal 22. Inquiry about nocturnal muscle spasms would be most significant when taking the
musculoskeletal history of a. adolescents. b. infants. c. older adults. d. middle adulthood. e. children. 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. REF: p. 510 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 23. 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. e. the remainder of the physical examination is completed. ANS: A
When the patient first walks in the room, the examiner should observe the gait and posture as part of the musculoskeletal examination. REF: p. 510 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 24. Pain, disease of the muscle, and damage to the motor neuron may all cause a. bony hypertrophy. b. muscle crepitus. c. muscle hypertrophy. d. muscle wasting. e. claudication. ANS: D
Muscle wasting is a consequence of pain from injury, pathology of the muscle, and injury to the motor neuron. REF: p. 510 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 25. An increase in muscle tone is known as a. crepitus. b. effusion. c. tenosynovitis. d. atrophy.
e. spasticity. ANS: E
An increase in muscle tone is referred to as spasticity. Crepitus, effusion, and tenosynovitis do not relate to muscle, and atrophy is wasting or a decrease in muscle mass. REF: p. 530 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 26. Fasciculation occurs after injury to a muscle’s a. venous return. b. motor neuron. c. strength. d. tendon. e. fascia. ANS: B
Fasciculations can often by 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. REF: p. 510 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 27. The physical assessment technique most frequently used to assess joint symmetry is a. inspection. b. palpation. c. percussion. d. the use of joint calipers. e. auscultation. ANS: A
The assessment technique most commonly used to assess joint symmetry is inspection. Palpation, percussion, auscultation, and the use of joint calipers are not commonly used for this purpose. REF: p. 510 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 28. A goniometer is used to assess a. bone maturity. b. joint proportions. c. range of motion. d. muscle strength. e. body fat. ANS: C
The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits. Muscle strength, bone maturity, body fat, and joint proportions are not measured by a goniometer.
REF: p. 511 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 29. When palpating joints, crepitus may be caused 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. e. there is muscle wasting. ANS: A
Crepitus is felt or heard when irregular bony surfaces rub together. Spastic muscles, muscle wasting, lax joints, and excess synovial fluid do not produce this grating sound upon palpation. REF: p. 510 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 30. The temporomandibular joint is palpated a. under the mandible anterior to the sternocleidomastoid muscle. b. from inside the mouth. c. anterior to the tragus. d. at the mastoid process. e. above the mandible at midline. 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. Under the mandible, above the mandible, and at the mastoid process do not describe the location of the temporomandibular joint. REF: p. 516 TOP: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 31. Temporalis and masseter muscles are evaluated by a. having the patient frown. b. having the patient clench his or her teeth. c. asking patient to fully extend his or her neck. d. passively opening the patient’s jaw. e. having the patient shrug his or her shoulders. ANS: B
Having the patient bite down and clench his or her teeth is the method to examine the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver. REF: p. 516 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 32. The strength of the trapezius muscle is evaluated by having the patient a. clench his or her teeth during muscle palpation. b. push his or her head against the examiner’s hand. c. straighten his or her leg with examiner opposition.
d. uncross his or her legs with examiner resistance. e. adduct the arm. ANS: B
Having the patient apply opposite force with differing head motions, against the examiner’s hand, assesses the sternocleidomastoid and trapezius muscles. REF: p. 518 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 33. Expected normal findings during inspection of spinal alignment include a. asymmetrical skinfolds at the neck. b. slight right-sided scapular elevation. c. convex lumbar curve. d. head positioned superiorly to the gluteal cleft. e. convex cervical curve. ANS: D
Spinal alignment is considered within normal limits when the patient’s head is positioned directly over the gluteal cleft. The skin folds should be symmetrical, the scapulae are at even heights, and both the cervical and lumbar curves are concave. REF: p. 518 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 34. A common finding in markedly obese and pregnant women is a. kyphosis. b. lordosis. c. paraphimosis. d. scoliosis. e. phimosis. ANS: B
Bowing of the back, or lordosis, is more commonly found in pregnant women and obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults, and scoliosis is more commonly seen in teenagers. Phimosis and paraphimosis are penile conditions. REF: p. 533 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 35. When the patient flexes forward at the waist, what spinal observation would lead you to
suspect scoliosis? a. A prominent lumbar hump b. A prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips e. A gibbus 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.
REF: p. 519 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 36. When the shoulder contour is asymmetrical and one shoulder has hollows in the rounding
contour, you would suspect a. a dislocated elbow. b. a fractured scapula. c. a dislocated shoulder. d. muscle wasting. e. kyphosis. ANS: C
Asymmetrical 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, a dislocated elbow, and a scapula fracture do not present with these symptoms. REF: p. 514 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 37. Ulnar deviation and boutonniere deformities are characteristic of a. winged scapula. b. osteoarthritis. c. osteoporosis. d. congenital defects. e. rheumatoid arthritis. ANS: E
Deviation of the fingers toward the ulnar side and boutonniere deformities are classic symptoms of rheumatoid arthritis. Winged scapula, osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms. REF: p. 513 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 38. A finding that is indicative of osteoarthritis is a. swan neck deformities. b. Bouchard nodes. c. ganglion cysts d. Heberden nodes. e. spindle-shaped fingers. 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 and spindle-shaped fingers; ganglion cysts are not associated with osteoarthritis. REF: p. 513 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
39. A tingling sensation radiating from the wrist to the hand on striking the median nerve is a
positive _____ sign. a. Phalen b. Gower c. Homan d. Tinel e. Allis ANS: D
The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers. REF: p. 524 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 40. Classic carpal tunnel syndrome would result in a. pain in the fourth and fifth digits. b. a negative Phalen test. c. reduced abduction of the thumb. d. palm tingling. e. a negative Tinel sign. ANS: C
Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, a positive Phalen sign, reduced abduction of the thumb, and sparing of palm tingling. The median half of the fourth digit and entire fifth digit are asymptomatic. REF: p. 524 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 41. Excessive hyperextension of the knee with weight bearing may indicate a. advanced joint degeneration. b. early signs of gout. c. rotation of the Achilles tendon. d. a meniscal tear. e. weakness of the quadriceps muscle. ANS: E
Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. Gout, joint degeneration, Achilles tendon rotation, and meniscal tears do not cause hyperextension of the knee. REF: p. 521 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 42. Arm length is measured from the acromion process through the a. olecranon joint to carpal thumb hinge. b. olecranon process to distal ulnar prominence. c. proximal radial prominence to distal joint. d. proximal ulnar joint to middle fingertip. e. olecranon process to the second fingertip.
ANS: B
Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow (olecranon process) joint to the wrist (distal ulnar prominence). REF: p. 529 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 43. A positive straight leg raise test usually indicates a. leg length discrepancy. b. knee instability. c. lumbar nerve root irritation. d. hip bursitis. e. improperly conditioned muscles. ANS: C
Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with the neck flexed and to raise one leg. If pain is felt, it is a positive straight leg raise result. The straight leg raise test does not assess leg length, knee stability, hip bursitis, or muscle condition. REF: p. 526 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 44. The Thomas test is used to detect a. hip dislocation. b. unstable sacroiliac joints. c. knee instability. d. flexion contractures of the hip. e. asymmetry in the level of the iliac crests. ANS: D
The Thomas test requires the patient to lie supine with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. The Thomas test does not assess hip dislocation, sacroiliac joints, knee instability, or asymmetry of the iliac crests. REF: p. 526 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 45. Which one of the following techniques is used to detect a torn meniscus? a. Phalen test b. McMurray test c. Thomas test d. Trendelenburg test e. Drawer test ANS: B
The McMurray test points to a meniscus tear. The Phalen test detects carpal tunnel syndrome. The drawer test detects an anterior cruciate ligament tear, the Thomas test detects hip contraction, and the Trendelenburg test detects weak hip abductor muscles.
REF: p. 527 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 46. When performing the drawer test, the examiner would place the patient in a supine position
and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. grasp the lower leg with both hands and draw the tibia forward and then backward. d. apply varus stress with the foot planted. e. apply valgus stress after the leg is extended. ANS: C
The next step is to place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity. Draw the tibia forward, forcing the tibia to slide forward of the femur. Then push the tibia backward. Anterior or posterior movement of the knee greater than 5 mm in either direction is an unexpected finding. REF: p. 527 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 47. Anterior cruciate ligament integrity is assessed via the _____ test. a. Lachman b. straight leg raise c. valgus stress d. Homan e. Thomas ANS: A
The Lachman test evaluates anterior cruciate ligament integrity. The straight leg raise test assesses nerve root damage, the valgus stress test assesses instability of the lateral and medial collateral ligaments, the Homan test assesses for blood clots in the legs, and the Thomas test is used to detect flexion contractures of the hips. REF: p. 528 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 48. During a football game, a player was struck on the lateral side of the left leg while his feet
were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the _____ test. a. varus stress b. valgus stress c. Apley d. Lachman e. drawer ANS: B
The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus. REF: p. 528 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
49. Term infants normally resist a. ankle dorsiflexion. b. McMurray test. c. forefoot adduction. d. knee extension. e. elbow flexion. ANS: D
Along with elbows and hips, newborns tend to resist extension of the knee; however, movements should be symmetrical. REF: p. 529 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 50. What technique is performed at every infant examination during the first year of life to detect
hip dislocation? a. Ballottement maneuvers b. Barlow-Ortolani maneuvers c. Range of motion d. Thomas McMurray assessment e. Trendelenburg test ANS: B
At every examination during an infant’s first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation and is signified by a clicking noise with the maneuver. REF: p. 530 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 51. You note that a child has a positive Gower sign. You know that this indicates generalized a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy. e. scoliosis. ANS: B
Gower sign is generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee, pushing down on the thighs while trying to pull up the trunk. It is often associated with muscular dystrophy. REF: p. 532 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 52. A 3-year-old boy is brought to the clinic complaining of a painful right elbow. He is holding
the right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of a. radial head subluxation. b. femoral anteversion.
c. carpal tunnel syndrome. d. Osgood-Schlatter disease. e. osteomyelitis. ANS: A
The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid’s elbow. The symptoms are not consistent with femoral anteversion, carpal tunnel syndrome, Osgood-Schlatter disease, or osteomyelitis. REF: p. 542 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 53. What temporary disorder may be experienced by pregnant women during the third trimester
because of fluid retention? a. Carpal tunnel syndrome b. Osteitis deformans c. Radial head subluxation d. Talipes equinovarus e. Legg-Calvé-Perthes disease ANS: A
Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms of the syndrome. REF: p. 533 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 54. A red, hot swollen joint in a 40-year-old man should lead you to suspect a. trauma. b. bursitis. c. gout. d. cellulitis. e. tenosynovitis. ANS: C
Gout is characterized as red, hot swollen joints, especially the great toe. Gout is commonly linked to men older than 40 years. REF: p. 536 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 55. An adult with bowed tibias and a shortened thorax may have a. ankylosing spondylitis. b. Paget disease. c. rheumatoid arthritis. d. Dupuytren contracture. e. Sprengel deformity. ANS: B
Paget disease is characterized by bowed tibias, asymmetric skull, shortened chest, and susceptibility to fractures.
REF: p. 537 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 56. In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis
typically exhibits a. metatarsus adductus. b. depression. c. sudden onset. d. less weakness and fatigue. e. pain most pronounced after periods of rest. ANS: D
One of the key differences between the symptoms of osteoarthritis and those of RA is that fatigue is uncommon in osteoarthritis patients. The joints of patients with RA are stiff after rest. REF: p. 538 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 57. A 45-year-old laborer presents with low back pain, stating that the pain comes from the right
buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression? a. Positive straight leg raise result b. Positive Trendelenburg sign c. Negative Romberg test result d. Contralateral straight leg raise result e. Positive drawer test result ANS: D
This patient, according to the pattern of radiculopathy, has an L3–L4 injury to the right side. The most alarming finding would be crossover pain to the affected leg while raising the unaffected leg because this finding is more suggestive of herniation. REF: p. 526 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 58. Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would
perform a a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test. d. tibial torsion test. e. Lachman test. ANS: B
The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm results for hip dislocation. REF: p. 530 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
59. A 7-year-old child who begins to limp and complains of persistent hip pain may have a. myelomeningocele. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis. e. congenital hip dislocation. ANS: C
Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by inadequate blood supply. Myelomeningocele, Dupuytren contracture, osteoarthritis, and congenital hip dislocation are not characterized by age group and these symptoms. REF: p. 541 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 60. Dupuytren contracture affects the a. hip flexor muscle. b. plantar fascia. c. carpal tunnel. d. palmar fascia. e. rotator cuff. ANS: D
A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture. REF: p. 543 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 61. A dowager hump is a. the hallmark of osteoporosis. b. pathognomic of scoliosis. c. indicative of tendonitis. d. characteristic of rickets. e. indicative of muscular dystrophy. ANS: A
Osteoporosis leads to vertebral compression and kyphotic bowing of the spine known as dowager’s hump. REF: p. 543 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal
Chapter 22: Neurologic System Test Bank—Medical MULTIPLE CHOICE 1. The autonomic nervous system coordinates which of the following? a. High-level cognitive function b. Balance and affect c. Internal organs of the body d. Balance and equilibrium e. Emotions and behavior ANS: C
The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function. REF: p. 544
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
2. The major function of the sympathetic nervous system is to a. orchestrate the stress response. b. coordinate fine motor movement. c. determine proprioception. d. contribute input from visual, labyrinthine, and proprioceptive sources. e. perceive stereognosis. ANS: A
Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for emergencies for fight or flight (stress response). The cerebellum plays a key role in the coordination of fine motor movements. Recognition of body parts and awareness of body position (proprioception) are dependent on the parietal lobe. The basal ganglia contribute input from visual, labyrinthine, and proprioceptive sources. Stereognosis is the ability to perceive weight and form of solid objects by touch and is not under sympathetic control. REF: p. 544
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
3. The parasympathetic nervous system maintains the day-to-day function of a. digestion. b. response to stress. c. lymphatic supply to the brain. d. lymphatic drainage of the brain. e. coordinating fine motor movements. ANS: A
The parasympathetic division functions in a complementary and a counterbalancing manner to conserve body resources and maintain day-to-day body functions such as digestion and elimination. REF: p. 544
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
4. Cerebrospinal fluid serves as a a. motor nerve impulse transmitter. b. red blood cell conveyer. c. shock absorber. d. mediator of voluntary skeletal movement. e. sensory nerve impulse transmitter. ANS: C
Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber. Neurotransmitters are chemicals that transmit nerve impulses from one nerve cell to another. The cerebrospinal fluid does not play a role in red blood cells or in voluntary skeletal movement. REF: p. 545
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
5. The motor cortex of the brain is in the a. corpus callosum. b. frontal lobe. c. limbic system. d. occipital lobe. e. parietal lobe. ANS: B
The frontal lobe contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements. The corpus callosum interconnects the counterpart areas in each hemisphere, unifying the cerebrum’s higher sensory and motor functions. The limbic system mediates the sense of smell and certain patterns of behavior that determine survival, such as mating, aggression, fear, and affection. The occipital lobe contains the primary vision center and provides interpretation of visual data. The parietal lobe is primarily responsible for processing sensory data as they are received. REF: p. 546
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
6. The thalamus is the major integration center for perception of a. speech. b. olfaction. c. pain. d. thoughts. e. visceral responses to emotions. ANS: C
The thalamus is the major integrating center for perception of various sensations such as pain and temperature, serving as the relay center between the basal ganglia and cerebellum. The reception of speech and interpretation of speech is located in the Wernicke area. The olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to plan, and enables you to imagine and think. The limbic system mediates the sense of smell and certain patterns of behavior (primitive behaviors, visceral response to emotional and biologic rhythms) that determine survival, such as mating, aggression, fear, and affection. REF: p. 546
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
7. The awareness of body position is known as a. extrapyramidal. b. graphesthesia. c. stereognosis. d. two-point discrimination. e. proprioception. ANS: E
Recognition of body parts and awareness of body position is known as proprioception. This is dependent on the parietal lobe. REF: p. 546
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
8. Which area of the brain is responsible for perceiving sounds and for determining their source? a. Frontal lobe b. Occipital lobe c. Parietal lobe d. Temporal lobe e. Brainstem ANS: D
The temporal lobe is responsible for the perception and interpretation of sounds and determination of their source. The frontal lobe contains the motor cortex associated with voluntary skeletal movement. The occipital lobe contains the primary vision center. The parietal lobe is primarily responsible for processing received sensory data. The brainstem is the pathway between the cerebral cortex and the spinal cord, and it controls many involuntary functions. REF: p. 546
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
9. Nerves that arise from the brain rather than the spinal cord are called a. sympathetic. b. parasympathetic. c. cranial. d. autonomic. e. lower motor neurons. ANS: C
Cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord. Sympathetic, parasympathetic, and autonomic refer to the autonomic nervous system. Lower motor neurons arise in the spinal cord. REF: p. 547
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
10. If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires
further evaluation? a. CN I, olfactory b. CN V, trigeminal c. CN IX, glossopharyngeal d. CN XI, spinal accessory
e. CN XII, hypoglossal ANS: D
CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with smell reception and interpretation. CN V is associated with opening of the jaw; chewing; and sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex, taste, secretion of salivary glands, carotid reflex, and swallowing. CN XII is associated with movement of the tongue. REF: p. 553
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
11. The major portion of brain growth and myelinization occurs between ____ year(s) of age. a. birth and 1 b. 2 and 3 c. 4 and 7 d. 11 and 14 e. 16 and 21 ANS: A
The major portion of brain growth occurs in the first year of life along with myelinization of the brain and nervous system. REF: p. 549
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
12. Motor maturation proceeds in an orderly progression from a. peripheral to central. b. head to toe. c. lateral to medial. d. pedal to cephalic. e. toe to head. ANS: B
Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck develops first followed by the trunk and extremities. The other choices are incorrect because they relate maturation sequence inappropriately. REF: p. 549
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
13. Normal changes of the aging brain include a. increased velocity of nerve conduction. b. diminished perception of touch. c. increased total number of neurons. d. decreased dermatomes. e. diminished intelligence quotient. ANS: B
Sensory perceptions of touch and pain are diminished by aging. The velocity of nerve impulse conduction declines, so response to stimuli takes longer. The number of cerebral neurons is thought to decrease by 1% a year beginning at 50 years of age; however, the vast number of reserve cells inhibits the appearance of clinical signs. Dermatomal patterns do not change. Acquired knowledge is maintained throughout life.
REF: p. 549
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
14. The area of body surface innervated by a particular spinal nerve is called a a. dermatome. b. nerve pathway. c. spinal accessory area. d. cutaneous zone. e. spinal tract. ANS: A
The sensory and motor fibers of each spinal nerve supply and receive information to a segment of skin known as a dermatome. Nerve pathway and spinal accessory area refer to nerve routes; cutaneous zone refers to a skin area that transmits fine mechanical information and normal exogenous thermal information at the same time. Spinal tracts are located in the spinal cord. REF: p. 547
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
15. Environmental hazards and cognitive function are data needed for the personal and social
history section of a neurologic assessment for a. adolescents. b. every patient. c. persons with seizures. d. pregnant women. e. infants. ANS: B
Exposure to lead, arsenic, insecticides, organic solvents, dangerous equipment, and work at heights or in water are important factors to consider in the personal and social history of all patients. REF: p. 551
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
16. A neurologic past medical history should include data about a. family patterns of dexterity and dominance. b. circulatory problems. c. educational level. d. immunizations. e. allergies. ANS: B
The neurologic past medical history should include data concerning neurovascular problems such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical information for the neurologic past medical history. REF: p. 551
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
17. When assessing superficial pain, touch, vibration, and position perceptions, you are testing a. motor function. b. cerebellar function. c. sensory function.
d. tendon reflexes. e. emotional status. ANS: C
Superficial pain, touch, vibration, and position perceptions are sensory functions. Cerebellar function and tendon reflexes are neuromuscular functions, and emotional status is regulated in the amygdala within the temporal lobe. REF: p. 561
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
18. You are examining a patient in the emergency department who has recently sustained head
trauma. To initially assess this patient’s neurologic status, you would a. ask him to discriminate between the smell of orange and peppermint. b. test the six cardinal points of gaze. c. palpate the jaw muscles as the patient clenches teeth. d. observe for swallowing and test the gag reflex. e. test the patient’s tongue movements. ANS: B
The sixth cranial nerve is commonly one of the first to lose function in the presence of increased intracranial pressure. Testing of the six cardinal points of gaze involves CN VI, which would be a priority. REF: p. 554
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
19. You are initially evaluating the equilibrium of Ms. Q You ask her to stand with her feet
together and arms at her sides. She loses her balance. Ms. Q has a positive a. Kernig sign. b. Homan sign. c. McMurray test. d. Romberg sign. e. Murphy sign. ANS: D
The Romberg test has the patient stand with his or her eyes closed, feet together, and arms at the sides. Slight swaying movement of the body is expected but not to the extent of falling. Loss of balance results in a positive Romberg test. Kernig sign tests for meningeal irritation, Homan sign tests for venous thrombosis, and McMurray test is a rotation test for demonstrating a torn meniscus. A positive Murphy sign is usually a sign of gallbladder disease. REF: p. 559
TOP: Discipline: Neuroscience
20. The finger-to-nose test allows assessment of a. coordination and fine motor function. b. point location. c. sensory function. d. two-point discrimination. e. stereognosis. ANS: A
MSC: Organ System: Nervous
To perform the finger-to-nose test, the patient closes both eyes, and touches his or her nose with the index finger, alternating hands while gradually increasing the speed. This tests coordination and fine motor skills. All of the other choices test sensory function without motor function. REF: p. 557
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
21. You are performing a two-point discrimination test as part of a well physical examination. The
area with the ability to discern two points in the shortest distance is the a. back. b. palms. c. fingertips. d. upper arms. e. chest. ANS: C
On the fingertips and toes, two points are commonly felt when 2 to 8 mm apart. A greater distance is expected for discrimination of two points on other body parts, such as the back (40 to 70 mm) or chest and forearms (40 mm). REF: p. 562
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
22. As Mr. B enters the room, you observe that his gait is wide based and he staggers from side to
side while swaying his trunk. You would document Mr. B’s pattern as a. dystonic ataxia. b. cerebellar ataxia. c. steppage gait. d. tabetic stamping. e. Parkinsonian gait. ANS: B
A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide based with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk. Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar flexed foot off the ground. The foot is brought down with a slap, and the patient is unable to walk on the heels. Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground. In Parkinsonian gait, the patient’s posture is stooped, and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping. REF: p. 559
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
23. Deep pressure tests are used mostly for patients who are experiencing a. absent superficial pain sensation. b. gait and stepping disturbances. c. lordosis, osteoporosis, or arthritis. d. brisk reflexes. e. tonic neck or torso spasms. ANS: A
Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle, thus causing discomfort. When superficial pain sensation is not intact, then further assessments of temperature and deep pressure sensation are performed. REF: p. 561
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
24. To assess a cremasteric reflex, the examiner strokes the a. skin around the anus and observes for the anal wink. b. abdomen and observes whether the umbilicus moves away from the stimulus. c. inner thigh and observes whether the testicle and scrotum rise on the stroked side. d. palm and observes whether the fingers attempt to grasp. e. sole of the foot and observes whether the toes fan down and out. ANS: C
Stroking the inner thigh of a male patient (proximal to distal) will elicit the cremasteric reflex. The testicle and scrotum rise on the stroked side. Stoking the skin around the anus produces reflexive contracture of the external anal sphincter referred to as the anal wink. Stroking the sole of the foot elicits a Babinski sign, stroking the abdomen elicits an abdominal reflex, and stroking the palm elicits a palmar grasp. REF: p. 562
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
25. You have asked a patient to close his eyes and identify an object placed in his hand. You are
evaluating a. stereognosis. b. graphesthesia. c. vibratory sense. d. two-point discrimination. e. extinction phenomenon. ANS: A
Stereognosis is the ability to recognize an object through touch and manipulation. Tactile agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion. Graphesthesia tests the patient’s ability to identify the figure being drawn on his or her palm. The vibratory sense uses a tuning fork placed on a bony prominence. Two-point discrimination uses two sharp objects to determine the distance at which the patient can no longer distinguish the two points. The extinction phenomenon tests sensation by simultaneously touching bilateral sides of the body with a sterile needle. REF: p. 562
TOP: Discipline: Neuroscience
26. The ability to recognize a number traced on the skin is called a. stereognosis. b. graphesthesia. c. extinction phenomenon. d. two-point discrimination. e. proprioception. ANS: B
MSC: Organ System: Nervous
The ability to recognize a number traced on the skin is called graphesthesia. Stereognosis is the ability to recognize an object through touch and manipulation. The extinction phenomenon test and two-point discrimination assess the person’s ability to discern the number of pinpoints and their location. Proprioception is the sensation of position and muscular activity originating from within the body. REF: p. 562
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
27. Which one of the following conditions is consistent with Brown-Séquard syndrome? a. Central sensory loss that is generalized b. Motor paralysis on lesion side of the body c. Multiple peripheral neuropathy of the joints d. Spinal root paralysis below the umbilicus e. Pain and temperature loss on lesion side of body ANS: B
Partial spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and temperature sensation loss occur one to two dermatomes below the lesion on the opposite side of the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of the body. REF: p. 562
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
28. To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested? a. Triceps b. Patellar c. Biceps d. Achilles e. Brachioradial ANS: B
To assess spinal levels L2 to L4, the patellar reflex should be tested. The patellar tendon is the only deep tendon that assesses the lumbar spinal level. The triceps, biceps, and brachioradial deep tendon reflexes are tested to assess the cervical spine, and the Achilles tendon is tested to assess the sacral spine. REF: p. 563
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
29. When using a monofilament to assess sensory function, the examiner a. uses two simultaneous monofilaments on similar bilateral points and then b. c. d. e.
compares results. applies both a monofilament and a pin on similar bilateral points and then compares results. applies pressure to the monofilament until the filament bends. strokes the monofilament along the skin from proximal to distal areas. assesses only the dorsal surface of the foot with the patient’s eyes open.
ANS: C
The monofilament is placed on several smooth spots of the patient’s plantar foot for 1 seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament.
REF: p. 565
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
30. Visible or palpable extension of the elbow is caused by reflex contraction of which muscle? a. Serratus anterior b. Biceps c. Pectoralis major d. Triceps e. Deltoid ANS: D
The triceps tendon, when directly hit with the reflex hammer just above the elbow, will cause contraction of the triceps muscle and extension of the elbow. REF: p. 564
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
31. It is especially important to test for ankle clonus if a. deep tendon reflexes are hyperactive. b. the patient has a positive Kernig sign. c. the Romberg sign is positive. d. the patient has peripheral neuropathy. e. deep tendon reflexes are hypoactive. ANS: A
Test the ankle clonus when reflexes are hyperactive. Support the patient’s knee in a flexed position and briskly dorsiflex the foot with your other hand. If clonus is present, there is recurrent ankle plantar flexion movement as long as the examiner retains the foot in dorsiflexion. Sustained clonus signifies the hypertonia of an upper motor neuron lesion. REF: p. 565
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
32. Which sign is associated with meningitis and intracranial hemorrhage? a. Babinski sign b. Asymmetric tonic neck reflex c. Doll’s eye movement d. Nuchal rigidity e. Moro reflex ANS: D
A stiff neck or nuchal rigidity is a sign associated with meningitis and intracranial hemorrhage. Test this by lifting the head of the patient to touch the chin while the patient lies in a supine position. Pain and resistance to neck motion are associated with nuchal rigidity. All of the other options are expected findings in infants and are not related to meningitis in adults. REF: p. 565
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
33. When assessing a 17-year-old patient for nuchal rigidity, you gently raise his head off the
examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test result, you would also perform a test for the _____ sign. a. Kernig b. Babinski c. obturator
d. Brudzinski e. Murphy ANS: A
The first action elicited the Brudzinski sign. This sign is an indicator of meningeal irritation. To confirm meningeal irritation, you would test for the Kerning sign, also a meningeal sign. REF: p. 566
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
34. On a scale of 0 to 4+, which deep tendon reflex score is appropriate for a finding of clonus in
a patient? a. 0 b. 1+ c. 2+ d. 3+ e. 4+ ANS: E
0 indicates absent reflexes; 1+ indicates sluggish or diminished reflex; 2+ indicates active or expected response; 3+ indicates more brisk than expected, slightly hyperactive; and 4+ indicates brisk, hyperactive, with intermittent or transient clonus. REF: p. 564
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
35. Cranial nerve XII may be assessed in an infant by a. watching the infant’s facial expressions when crying. b. observing the infant suck and swallow. c. clapping hands and watching the infant blink. d. observing the infant’s rooting reflex. e. checking the infant’s gag reflex. ANS: B
Cranial nerve (CN) XII may be assessed in an infant by observing the infant suck and swallow and by pinching the nose and then observing for the mouth to open and the tip of the tongue to rise in a midline position. Watching the infant’s facial expressions when crying assesses CN VII, clapping hands and watching the infant blink tests CN VIII, and observing the rooting reflex assesses CN V. A gag reflex assesses CN IX and X. REF: p. 567
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
36. At what age should an infant begin to transfer objects from hand to hand? a. 2 months b. 4 months c. 7 months d. 10 months e. 12 months ANS: C
Transferring objects hand to hand begins at 7 months. Purposeful release of objects is noted as a normal finding by 10 months. Purposeful movements, such as reaching and grasping for objects, begin at about 2 months of age. The progress of taking objects with one hand begins at 6 months. There should be no tremors or constant overshooting of movements.
REF: p. 566
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
37. A positive Babinski sign is normal until what age? a. 3 to 6 months b. 9 to 15 months c. 16 to 24 months d. 3 years e. 5 years ANS: C
A positive Babinski sign, fanning of the toes and dorsiflexion of the great toe, is a normal finding until the infant is 16 to 24 months old. REF: p. 568
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
38. Which of the following is a concern, rather than an expected finding, in older adults? a. Reduced ability to differentiate colors b. Bilateral pillrolling of the fingers c. Absent plantar reflex d. Diminished senses of smell and taste e. Reduced gag reflex ANS: B
Bilateral pillrolling is indicative of Parkinson disease; the other choices are expected findings with aging. REF: p. 579
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
39. Ipsilateral Horner syndrome indicates a cerebrovascular accident (CVA) occurring in the a. anterior spinal artery. b. internal or middle cerebral artery. c. posterior inferior cerebellar artery. d. vertebral or basilar arteries. e. anterior portion of the pons. ANS: C
The posterior inferior cerebellar artery supplies the lateral and posterior portion of the medulla. A CVA involving this artery can produce a neurologic sign of ipsilateral Horner syndrome in the eye. REF: p. 576
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
40. An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14
days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is a. cerebral palsy. b. HIV encephalopathy. c. Guillain-Barré syndrome. d. Rett syndrome. e. myasthenia gravis.
ANS: C
Guillain-Barré syndrome (acute idiopathic polyneuritis) is an acute polyradiculoneuropathy that commonly follows a nonspecific infection that occurred 10 to 14 days earlier. It is characterized by ascending symmetrical weakness with sensation preserved. An increase in the severity occurs over days or weeks. A decrease or absent strength and sensory loss may result along with motor paralysis and respiratory muscle failure. REF: p. 577
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
41. The immune system attacks the synaptic junction between the nerve and muscle fibers
blocking acetylcholine receptor sites in a. myasthenia gravis. b. encephalitis. c. multiple sclerosis. d. cerebral palsy. e. trigeminal neuralgia. ANS: A
Myasthenia gravis is a chronic autoimmune neuromuscular disease involving the lower motor neurons and muscle fibers. The immune system of infected individuals produces antibodies that destroy acetylcholine receptor sites at the neuromuscular junction. This blocks the nerve impulse from reaching the muscle and produces muscle fatigue. REF: p. 576
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
42. Diabetic peripheral neuropathy will likely produce a. hyperactive ankle reflexes. b. diminished pain sensation. c. exaggerated vibratory sense. d. hypersensitive temperature perception. e. exaggerated sharp touch sensation. ANS: B
Peripheral neuropathy is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, more commonly in the hands and feet. Patients may have sensation of numbness, tingling, burning, and cramping. In moderate to severe diabetic neuropathy, the patient has wasting of the foot muscles, absent ankle and knee reflexes, decreased or no vibratory sensation below the knees, or loss of pain or sharp touch sensation to the mid-calf level. REF: p. 578
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
43. Persons with Parkinson disease have an altered gait that is characterized by a. short shuffling steps. b. the trunk in a backward position. c. exaggerated swinging of the arms. d. lifting the legs in a high-step fashion. e. wide-based, staggering, and lurching steps. ANS: A
The altered gait of Parkinson disease has short shuffling steps, the posture is stooped forward, and the arms have limited swing. REF: p. 579
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
44. A clinical syndrome of intracranial hypertension that mimics brain tumors is a. meningitis. b. myasthenia gravis. c. Guillain-Barré syndrome. d. pseudotumor cerebri. e. Bell palsy. ANS: D
Pseudotumor cerebri is a clinical syndrome of intracranial hypertension that mimics brain tumors. Its cause is unknown, but one theory is that an impaired venous outflow leads to increased cerebral blood volume; it may also be idiopathic. REF: p. 574
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
Chapter 23: Sports Participation Evaluation Test Bank—Medical MULTIPLE CHOICE 1. The goals of preparticipation sports evaluation (PPE) include a. screening for steroid use or abuse. b. determining the best fit for positions in each sport. c. identify health problems that increase risk of injury or death during participation. d. securing a legal contract before recommending limiting participation. e. predict brain injury and concussion. ANS: C
The overall goal of the PPE is to ensure safe participation in an appropriate physical activity and not to restrict participation unnecessarily. A preparticipation evaluation may not predict a brain injury and concussion, but it can help you learn the normal neuropsychologic status of the person involved before injury. REF: p. 581 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 2. The checkout station for preparticipation physical evaluation (PPE) is critical because at this
point a. all completed forms are distributed. b. parental cosignatures are obtained. c. the relevant history is obtained. d. data is reviewed and follow-up actions coordinated e. a primary care visit will not be required. ANS: D
At the checkout station, data collected during the evaluation are reviewed, and necessary follow-up actions are shared with the athlete, parents, or both. In addition, the written report is distributed. If the PPE is not itself a comprehensive service that addresses issues unrelated to sports participation, the need for routine primary care remains. REF: p. 581 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 3. You are conducting a preparticipation physical examination for a 10-year-old girl with Down
syndrome who will be playing soccer. She has increased deep tendon reflexes, ankle clonus, and a positive Babinski sign. What would be your next course of action? a. Cervical spine radiograph b. Immediate referral to a neurosurgeon c. Mini-Mental State Examination d. Nerve conduction studies e. Visual acuity ANS: B
This girl is experiencing symptoms of atlantoaxial joint instability. These examination findings require immediate referral to a neurosurgeon with expertise in atlantoaxial instability.
REF: p. 582 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 4. Part of the screening orthopedic component of the examination includes evaluating the person
while a. performing push-ups. b. duck walking. c. twisting at the waist. d. crossing the arms over the chest. e. performing jumping-jacks. ANS: B
Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance. REF: p. 587 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 5. Your 15-year-old patient appears to have a too-thin body build. Radiography of an ankle
injury reveals a stress fracture. You should question this patient about her a. sleep patterns. b. salt intake. c. aerobic workouts. d. menstrual cycles. e. family history. ANS: D
A too-thin body encourages a low estrogen state and the possibility of menstrual dysfunction and a resultant osteopenia or osteoporosis. This state increases the risk of stress fractures. This patient should be questioned about amenorrhea. The thorough menstrual history is a critical component of the PPE in female athletes. REF: p. 593 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 6. One of the most important aspects to consider in all portions of the orthopedic screening
examination is a. muscle contraction. b. flexibility. c. muscle development. d. balance. e. symmetry. ANS: E
One of the most important aspects to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement. REF: p. 582 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 7. Which medical condition would exclude one from sports participation?
a. b. c. d. e.
Asthma Fever Controlled seizures Stage 1 hypertension Sickle cell trait
ANS: B
Fever can increase cardiopulmonary effort and impair exercise capacity; fever can indicate myocarditis or other infections that make exercise dangerous. Asthma, seizures, stage 1 hypertension, and sickle cell trait, when controlled, do not exclude exercise. REF: p. 587
TOP: Discipline: Pathophysiology
MSC: Organ System: General
8. Which of the following radiographic studies is no longer recommended by the American
Academy of Pediatrics (AAP) as a screening examination for individuals with Down syndrome? a. Skull x-rays b. Pelvic x-rays c. Cervical spine x-rays d. Thoracic spine x-rays e. Lumbar spine x-rays ANS: C
Individuals with Down syndrome are at increased risk of atlantoaxial subluxation. The AAP previously recommended routine radiologic screening of the cervical spine in asymptomatic children and adolescents. However, because radiographs do not accurately predict which children are at increased risk, the AAP no longer supports this practice. The other studies were never recommended as screening examinations. REF: p. 582 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 9. A parent is advised to restrict contact or collision sports participation for his or her child. An
example of a sport in which this child could participate is a. hockey. b. roller skating. c. track. d. skateboarding. e. diving. ANS: C
Hockey and diving are considered a contact or collision sport; roller skating and skateboarding are considered to be limited-contact sports. Track is a noncontact sport. REF: p. 587 TOP: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 10. Which of the following may be a component of the female athlete triad? a. Heavy menstrual periods b. Fevers c. Seizures
d. Weight gain e. Binging and purging ANS: E
A trio of problems, disordered eating, amenorrhea, and osteoporosis, defines the female athlete triad. An energy deficit may sometimes occur unintentionally but at other times intentionally (e.g., bingeing and purging; using laxatives, diuretics, and diet pills inappropriately). REF: p. 593
TOP: Discipline: Pathophysiology
MSC: Organ System: General
11. Which of the following statements is true regarding sports-related concussions? a. They are only caused by a direct blow to the head. b. They may or may not involve a loss of consciousness. c. They are usually associated with abnormal neuroimaging studies. d. Symptoms largely reflect structural rather than functional disturbances. e. They typically result in delayed onset of symptoms that rarely resolve
spontaneously. ANS: B
Sports-related concussions typically result in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course with 80% to 90% resolving in 7 to 10 days. The other statements are not true. REF: p. 588
TOP: Discipline: Pathophysiology
MSC: Organ System: General
Chapter 24: Putting it all Together Test Bank—Medical MULTIPLE CHOICE 1. Which of the following is true regarding the relationship between the examiner and the
patient? a. It is the examiner’s responsibility to help the patient understand that he or she is qualified to make decisions regarding health care. b. The patient must trust the examiner completely. c. The examiner–patient relationship is enhanced by ignoring cultural issues. d. The patient is a full partner with the examiner. e. The examiner–patient relationship should never have priority over strict information gathering. ANS: D
The enduring message of sound communication is that you care and that the patient is your full partner. The relationship becomes well-established through the powerful therapeutic effect of really listening to what the patient says, careful exploration for hidden concerns, and explaining information without patronizing. REF: p. 594
TOP: Discipline: Behavioral Science
MSC: Organ System: General
2. An examiner might be able to help a patient who seems uncomfortable with close contact
during an examination by a. acknowledging the discomfort. b. backing away from the patient. c. joking about the patient’s discomfort. d. moving briskly to completion. e. deferring parts of the examination. ANS: A
Acknowledging the patient’s discomfort during the examination will help the patient feel more relaxed. It may help to consistently provide an explanation of which part of the examination comes next and to be honest about the potential of uncertainty, discomfort, or pain and how long it will last. REF: p. 594
TOP: Discipline: Behavioral Science
3. At your first meeting with a patient, it is usually best to say a. “Let’s get to the point.” b. “I hope you will learn to trust me.” c. “Let me tell you what I can do for you.” d. “Tell me about yourself.” e. “What is the purpose of your visit today?” ANS: D
MSC: Organ System: General
Take the time to ask open-ended questions to ensure that the patient has the opportunity to report accurately. Too great an adherence to routine may prevent the true story from emerging. The other choices are not open ended, which does not allow the patient to elaborate. They are not phrases that are comforting to the patient and would make the patient feel uncomfortable on the initial meeting. REF: p. 594
TOP: Discipline: Behavioral Science
MSC: Organ System: General
4. Which one of the following patient characteristics is most likely to limit patient reliability
during history taking? a. The patient’s measured IQ is above average. b. The patient is alert and oriented to time and place. c. The patient’s sensory deprivation d. The patient speaks the same language as examiner. e. The patient appears emotionally stable. ANS: C
A partial or total loss of any of the senses can limit a patient’s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient’s ability to be a thorough historian. All of the other options would not limit a patient’s reliability. REF: p. 595
TOP: Discipline: Behavioral Science
MSC: Organ System: General
5. Which of the following is most likely to enhance examiner reliability? a. The examiner seeks confirmation from others when necessary. b. The examiner is uncomfortable with his or her own skills. c. The examiner believes he or she must always be correct. d. The examiner prejudges the patient and family. e. The examiners use of unselective technology. ANS: A
The examiner may not always be correct, but questioning yourself and seeking confirmation from others when necessary will serve to assure your reliability. A person should never be prejudged because this can interfere with your examination and findings. Showing that you are uncomfortable with your skills can make the patient feel uncomfortable and see you as unreliable. The use of unselective technology should not substitute for a well-honed history and physical examination. REF: p. 596
TOP: Discipline: Behavioral Science
MSC: Organ System: General
6. The reliability of health-related findings and observations is the responsibility of the a. patient. b. health care professionals. c. attending physician. d. patient and patient’s family. e. professional and the patient. ANS: E
It is the responsibility of the health professional and the patient to present reliable findings and observations. They work as a team.
REF: p. 595
TOP: Discipline: Behavioral Science
MSC: Organ System: General
7. Which of the following statements accurately reflects the sensitivity and specificity of
laboratory tests? a. Sensitivity and specificity are not related. b. Sensitivity and specificity are inversely correlated. c. Sensitivity and specificity are directly correlated. d. No test has 100% sensitivity and specificity. e. The “gold standard” test has 100% sensitivity and specificity. ANS: D
No test has 100% sensitivity and specificity. REF: p. 596
TOP: Discipline: Biostatistics
MSC: Organ System: General
8. As you greet the patient, which examination technique is first implemented? a. Auscultation b. Inspection c. Measurements d. Palpation e. Percussion ANS: B
Begin to inspect the patient as you greet him or her, as you look for signs of distress or disease. Inspect the patient’s appearance, gait, orientation, and difficulty in hearing or speech. REF: p. 597
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. Which of the following data are not part of your general inspection? a. Dress and habitus b. Sinus tenderness c. Gait d. Facial expression e. Degree of relaxation ANS: B
Upon meeting the patient, his or her facial expression, gait, dress, and habitus should be inspected. Inspecting for sinus tenderness is performed afterward if indicated. REF: p. 597
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. The sequence of the physical examination should be individualized to a. minimize the number of times that the patient must change positions. b. maximize the convenience of the examiner. c. improve patient flow. d. minimize the time the patient is in the room. e. maximize patient movements to assess their mobility. ANS: A
There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient’s energy. REF: p. 596
TOP: Discipline: Behavioral Science
MSC: Organ System: General
11. According to the usual examination procedure, you would first assist your patient to assume
which position? a. Lithotomy b. Prone c. Standing d. Supine e. Sitting ANS: E
Upon entering the examination room, you should assist the patient in the sitting position on the examining table. In the sitting position, you can examine the patient’s anterior and posterior upper trunk and head, which comprise the majority of focused assessments. REF: p. 600
TOP: Discipline: Behavioral Science
MSC: Organ System: General
12. An ophthalmoscopic eye examination involves a. lens inspection. b. near vision evaluation. c. sclera observation. d. visual field assessment. e. assessing extraocular eye muscles. ANS: A
Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope. REF: p. 598
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
13. The cranial nerves are usually assessed while the patient is in which position? a. Left lateral b. Supine c. Sitting d. Prone e. Standing ANS: C
While the patient is in the sitting position, you can assess all cranial nerve functions. REF: p. 600
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
14. Which of the following are examined with the patient in a reclining 45-degree position? a. Bilateral hips and popliteal angles b. Facial bones and cranial nerves V and VII c. Cardinal fields of gaze d. Oropharynx and thyroid gland placement
e. Jugular venous pulsation and pressure ANS: E
With the patient in a reclining 45-degree position, you can examine the jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position. REF: p. 599 TOP: Discipline: Physiology MSC: Organ System: Cardiovascular 15. Which patient position facilitates inspection of the chest and shoulders? a. Sitting b. Supine c. Trendelenburg d. Prone e. Lithotomy ANS: A
With the patient in the sitting position, the examiner can inspect the chest and shoulders. The area being inspected is exposed for the examiner to do a thorough assessment. The other positions are not used to assess the chest and shoulders. REF: p. 598
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. When assessing the abdomen, one needs to expose the patient a. from the waist down. b. from the pubis to the epigastrium. c. from the clavicles to the hips. d. at no point during the examination. e. in the entirety. ANS: B
While the patient is in the supine position, the examiner can assess the abdomen. Arrange draping to expose the abdomen from pubis to epigastrium, making sure to cover the private areas of the patient. All of the other options would not allow for a thorough inspection and examination or they would expose the patient inappropriately. REF: p. 600
TOP: Discipline: Behavioral Science
MSC: Organ System: General
17. To inspect the abdominal muscles, ask the a. supine patient to raise the head. b. standing patient to bend forward. c. prone patient to raise the lower legs. d. standing patient to stand on tiptoes. e. standing patient to lean backward. ANS: A
Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the other choices would not show the abdominal muscles contracting. REF: p. 600
TOP: Discipline: Physiology
MSC: Organ System: Musculoskeletal 18. Proprioception should be assessed while the patient is a. prone. b. supine. c. seated. d. standing. e. left lateral. ANS: D
Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations. REF: p. 601
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
19. Examination of the patient in the lithotomy, or knee–chest, position includes a. inspection for inguinal hernias. b. palpation of anal sphincter tone. c. percussion of pelvic structures. d. stereognosis testing. e. percussion of abdominal structures. ANS: B
With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position. REF: p. 602
TOP: Discipline: Behavioral Science
MSC: Organ System: General
20. Which portion of the physical examination is best done with the patient standing? a. Spinal b. Rectal c. Neck d. Musculoskeletal e. Chest ANS: A
With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and test the patient’s range of motion. REF: p. 601 TOP: Discipline: Physiology MSC: Organ System: Musculoskeletal 21. The greatest risk for potential health problems occurs in which age group? a. Newborn b. Toddler c. School age d. Adolescence e. Young adult ANS: A
The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups. REF: p. 602
TOP: Discipline: Biostatistics
MSC: Organ System: General
22. A common method of estimating gestational age of a newborn is to assess a. middle finger length. b. creases on the sole of the foot. c. umbilical placement. d. visual acuity. e. creases on the palm of the hand. ANS: B
To determine gestational age, look at the soles of the feet. Before 36 weeks’ gestation, only one or two transverse creases are present; by 40 weeks’ gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions. REF: p. 602
TOP: Discipline: Embryology
MSC: Organ System: Reproductive
23. To promote your examination time with a cooperative child, your approach to the examination
should be to a. ask the parent to give the child a bottle during the examination. b. sing songs with the child during the examination. c. conduct the physical examination on the child while the parent is holding the child. d. let the child play with examination room equipment to feel more comfortable. e. have the parent place the child in the prone position on the examination table. ANS: C
For children, the examination sequence depends on their cooperation for as long as possible. To promote this, examine the child while the parent is holding the child, while maximizing both inspection and opportunities for physical examination. REF: p. 603
TOP: Discipline: Behavioral Science
MSC: Organ System: General
24. When conveying “bad” or distasteful news to the patient and family, it is best to a. avoid provision of any information until the entire family is assembled. b. provide minimal information permitted by the patient. c. be specific in all details. d. rely on medical jargon to minimize distress. e. let the patient inform the family. ANS: C
When conveying bad or distasteful news to the patient and family, arrange a setting that is quiet. Involve those who have had contact with the patient and those who the patient trusts. Be specific in all details and provide the information in a timely fashion adjusted to the needs of the patient and allow time for questions. Use jargon-free language that the patient can understand. Inform the patient as soon as possible. Involve family members and other essential persons to give the patient emotional and practical support.
REF: p. 609
TOP: Discipline: Behavioral Science
MSC: Organ System: General
25. The examination of a newborn should begin with a. percussion. b. palpation. c. vital signs. d. auscultation. e. inspection. ANS: E
The examination of a newborn should begin with inspection, noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection. REF: p. 603
TOP: Discipline: Physiology
MSC: Organ System: Reproductive
26. The best way to ease the apprehension of a 3-year-old child before a physical examination is
to a. b. c. d. e.
explain that you will be gentle. have the parents leave the examination room. encourage child’s participation. tell the child he or she will get a lollipop for good behavior. hand the child a picture book.
ANS: C
The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the end piece of the stethoscope or to “blow out” your flashlight. REF: p. 606
TOP: Discipline: Behavioral Science
MSC: Organ System: General
27. In crying infants, it is often difficult to a. perform tactile fremitus assessments. b. determine lung expansion. c. auscultate heart sounds. d. visualize the pharynx. e. assess facial symmetry. ANS: C
For a crying infant, the lungs can be auscultated between consolable moments. While the infant is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Between breaths, the heart tone can be auscultated. REF: p. 603
TOP: Discipline: Physiology
MSC: Organ System: General
28. When you attempt to move a 10-month-old child from his mother’s lap to the examination
table, he screams loudly. Your best action is to a. move the child to the examination table and proceed matter-of-factly with the examination. b. perform the examination while the child is in the mother’s lap.
c. ask the mother to get the child to stop crying. d. defer the examination until another day. e. have the mother place the child on the examination table. ANS: B
The parent’s lap is a great “examination table” because it helps the child feel more at ease and is a good way to observe the nature of the parent–child relationship. None of the other actions would comfort the patient or make the situation better. REF: p. 603
TOP: Discipline: Behavioral Science
MSC: Organ System: General
29. Observation of the child playing in the playroom provides information about which two
systems? a. Dermatologic and cardiovascular b. Neurologic and musculoskeletal c. Respiratory and ear, nose, and throat d. Gastrointestinal and genitourinary e. Endocrine and hematopoietic ANS: B
A child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child’s coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping. REF: p. 606
TOP: Discipline: Physiology
MSC: Organ System: General
30. When conducting a geriatric assessment, basic activities of daily living (ADLs) include a. bathing. b. housekeeping. c. medication compliance. d. communication skills. e. money management. ANS: A
Basic ADLs include bathing, dressing, toileting, ambulating, and feeding. All of the choices represent instrumental ADLs. REF: p. 608
TOP: Discipline: Behavioral Science
MSC: Organ System: General
31. Functional assessment is most important during the examination of a(n) a. adolescent. b. infant. c. older adult. d. young adult. e. toddler. ANS: C
Functional assessment is most important when examining older adults. Initial observation and interaction can provide a great deal of information about the individual’s independent functional capacity. Attention should be given to self-care activities and instrumental activities.
REF: p. 608
TOP: Discipline: Behavioral Science
MSC: Organ System: General
32. Throughout the history and physical examination, the clinician should a. concentrate on emotional issues. b. follow an inflexible sequence. c. maintain a matter-of-fact demeanor. d. deal only with previously identified problems. e. evaluate the whole patient. ANS: E
The clinician should evaluate the whole patient, including his or her physical, emotional, and social needs. Learning how to follow a disciplined course and how to be flexible will help the clinician during the history and physical examination. The information obtained should be kept organized to provide essential patient care. REF: p. 609
TOP: Discipline: Behavioral Science
MSC: Organ System: General
33. Which of the following is not assessed in a newborn’s Apgar score? a. Color b. Heart rate c. Pupil reactivity d. Muscle tone e. Respirations ANS: C
The Apgar score, taken at 1 and 5 minutes of age, provides insight to the baby’s in utero, intrapartum, and immediate postnatal experience. A low score for several of the variables— color, heart rate, respirations, muscle tone, and reflex irritability—is evidence of difficulty. REF: p. 609
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 25: Taking the Next Steps: Critical Thinking Test Bank—Medical MULTIPLE CHOICE 1. In practice, the use of evidence a. is called evidence-based practice. b. replaces intuitive responses. c. makes intuitive responses inconsequential. d. affirms intuitive responses. e. need not undergo critical review. ANS: A
The best available evidence must be carefully obtained from the volumes of information available in books, journals, and online. Use of evidence in decision making is called evidence-based practice. REF: p. 610
TOP: Discipline: Behavioral Science
MSC: Organ System: General
2. After the subjective and objective data have been prioritized, the next step is to a. order laboratory tests. b. formulate a problem list. c. establish the diagnosis. d. initiate therapy. e. initiate appropriate consultations. ANS: B
Formulate problems as specifically as possible. Identify and list the signs and symptoms associated with each of patient’s concerns as well as abnormalities discovered during the physical examination. REF: p. 610
TOP: Discipline: Behavioral Science
MSC: Organ System: General
3. New symptoms or findings of unknown etiology are a. problems to be noted on the problem list. b. deferred for subsequent visits. c. diagnosed before physical examination. d. reserved for specialists. e. usually “red herrings.” ANS: A
New findings of unknown causes are added to the problem list, but do not let them become a “red herring” that distracts your attention from the central issues. REF: p. 610
TOP: Discipline: Behavioral Science
MSC: Organ System: General
4. Which of the following is an accepted method of making a diagnosis? a. Always unifying your findings into one diagnosis b. Making maximal use of laboratory tests c. Using first assumptions
d. Using algorithms e. Relying on intuition ANS: D
Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Unifying all of your findings into one diagnosis is not always possible. More than one disease process can exist at one time in the same patient. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions. REF: p. 611
TOP: Discipline: Behavioral Science
MSC: Organ System: General
5. The adage “common problems occur commonly” advises the practitioner to a. always diagnose the patient’s problem in terms of what their practice usually sees. b. refer any uncommon complaints to specialists as soon as possible. c. consider the most likely cause of the patient’s problem before considering the
obscure. d. examine uncommon problems critically before assuming that the issue is an
unusual presentation of a common problem. e. be aware that common problems never have unusual presentations. ANS: C
This adage is to guide practitioners to pay attention to unexpected or unusual findings but not let the critical review lead them astray from the central issue. Common problems can have unusual presentations, and rare ones may have a seemingly common complaint. REF: p. 611
TOP: Discipline: Behavioral Science
MSC: Organ System: General
6. The most important guide to sequencing actions should be a. probability and utility. b. avoid diagnoses with no available treatment. c. costs and risks of procedures. d. reimbursement potential and patient acceptance. e. assumption and intuition. ANS: A
Although all choices are relevant, probability and utility should always be your guides to sequencing your actions unless a life-threatening situation exists. A conscientious estimate of probability is the best way to define the limits of uncertainty, and the best way to establish priorities. REF: p. 611
TOP: Discipline: Behavioral Science
7. Examiner experience should result in a. an ability to stay focused on one’s favorite hypotheses. b. a reliance on intuition. c. an ability to order more laboratory tests. d. the need to spend more time with patients. e. the ability to analyze data with more confidence. ANS: E
MSC: Organ System: General
Experience gives more confidence, resulting in greater skill at being able to analyze, evaluate, and synthesize information about the chief complaint, and then arrive at a diagnosis. One must always remain cognizant that your favorite hypotheses may not be valid. REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
8. Medical decision making requires a balance between a. speculation and feelings. b. opinions and beliefs. c. knowledge and superstition. d. mechanism and probability. e. trust and suspicion. ANS: D
Medical decision making must have a balance between mechanism and probabilism (certainty in knowledge is impossible). REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. A valid history and physical examination can serve to a. create higher health care costs. b. supplement your opinion. c. threaten patient satisfaction. d. increase the risk of liability. e. limit indiscriminate use of diagnostics. ANS: E
A comprehensive history with a competent clinical examination can lead you to generate a more accurate problem list and therefore increase the proper utilization of diagnostic testing while limiting its indiscriminate use, which decreases health care costs. REF: p. 613
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. When evaluating results of laboratory tests, a test that is highly sensitive implies that the test a. suggests that a disease is present when it actually is not. b. will not have any false-positive results. c. suggests that a disease is absent when it is absent. d. is able to correctly identify for the disease being tested. e. is able to confirm a diagnosis even when the disease is not present. ANS: D
Testing that is sensitive is a test that will be able to correctly identify persons with the disease that the test has been designed to test for. Positive results are more likely to be positive for the disease. REF: p. 613
TOP: Discipline: Biostatistics
11. A specific test is one that has the ability to a. correctly identify those who have the disease. b. correctly identify those who do not have the disease. c. be exclusively used to make a diagnosis. d. suggest the presence of a disease that is not present.
MSC: Organ System: General
e. exclude competing explanations for another test finding. ANS: B
The specificity of a test is determined by its ability to identify those who do not have the disease that the test is designed to test for. Negative results are more likely to be valid. REF: p. 613
TOP: Discipline: Biostatistics
MSC: Organ System: General
12. The proportion of persons with an observation characteristic of a disease that have the disease
is known as _____ value. a. sensitivity positive specific b. negative specific c. positive predictive d. negative predictive e. true negative ANS: C
A positive predictive value is defined as the proportion of persons thought to have a disease who actually have the disease. REF: p. 613
TOP: Discipline: Biostatistics
MSC: Organ System: General
13. The likelihood of your diagnosis being related to your findings depends on a. the number of ancillary tests performed. b. the prevalence of both in the particular population. c. your ability to validate your first impression. d. your experience with the particular condition. e. the number and magnitude of the presenting problems. ANS: B
Bayes Theorem points out that the likelihood of a diagnosis you make being related to your clinical findings depends on the prevalence of each of these in the population you serve. REF: p. 613
TOP: Discipline: Behavioral Science
MSC: Organ System: General
14. Which of the following is not a component of a management plan? a. Presumptive diagnosis b. Subspecialty consultation c. Diet modification d. Follow-up visit e. Patient education ANS: A
The management plan details what you are going to do about a patient problem such as subspecialty consultations, diet modifications, follow-up visits, and any necessary patient education. REF: p. 614
TOP: Discipline: Behavioral Science
MSC: Organ System: General
15. When determining priorities for planned actions, the practitioner should a. address problems in the order of their chronologic development. b. consider whether the patient is concerned about a particular problem before
addressing it. c. ignore the patient’s social and economic circumstances. d. address the most urgent problem first. e. never consider if the cost of care will impact other areas of the patient’s life. ANS: D
In developing patient care plans, priority should be given to the most life threatening and urgent physical needs of the patient. Then focus on addressing the patient’s social and economic circumstances and whether the cost of care will impact other areas of the patient's life. REF: p. 614
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. Bits of information that are distracting and draw your thinking away from central issues are
referred to as a. Bayes Theorem. b. true negatives. c. mechanism and probabilism. d. red herrings. e. false negatives. ANS: D
Beware of red herrings, the bits of information that are distracting and draw your thinking away from central issues. Critically evaluate unexpected or unusual findings but do not let them distort full consideration of all you have learned. REF: p. 610
TOP: Discipline: Behavioral Science
MSC: Organ System: General
17. In issues surrounding ethical decision making, beneficence refers to the a. appropriate use of medical resources. b. care provider acting as a father or mother figure. c. care provider knowing what is best for the patient. d. need to avoid harming the patient. e. need to do good for the patient. ANS: E
The definition of beneficence is to do good, not being paternalistic, and the need to avoid harm refers to nonmaleficence. Utilitarianism is the appropriate use of resources for the greater good of the larger community. REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
18. The term denoting the caregiver’s need to do no harm to the patient is a. autonomy. b. deontologic imperative. c. nonmaleficence. d. utilitarianism. e. beneficence. ANS: C
The definition of nonmaleficence is to do no harm.
REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
19. The duties of care providers established by tradition and within the context of culture are
known as a. beneficence. b. allopathic imperatives. c. deontologic imperatives. d. utilitarian imperatives. e. paternalistic imperatives. ANS: C
The definition of deontologic imperatives is those duties of care that providers establish by tradition and within cultural contexts. REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
20. Which of the following is initially appropriate in the management of a patient’s diagnosed
problem? a. Inform the patient of the treatment plan. b. Give the patient detailed written instructions regarding the treatment plan. c. Inform the patient that the plan has been tailored to his needs. d. Inform the patient of treatment options and possible results. e. Lead the patient to an understanding that you know the best treatment option. ANS: D
An initial approach to a patient’s problem should allow for the greatest patient autonomy and should promote patient participation. The well-informed patient is better able to exercise autonomy. Only informing the patient of treatment options and possible results does this. REF: p. 612
TOP: Discipline: Behavioral Science
MSC: Organ System: General
21. Regarding stages of change, contemplation refers to a. not yet admitting a problem. b. admitting there is a problem. c. intending to take action. d. changing behavior. e. sustaining actions and working to prevent relapse. ANS: B
The contemplation stage of changing a behavior refers to admitting that there is a problem but not yet ready or sure of wanting to make a change, starting to think about pros and cons for continued action. REF: p. 615
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 26: Recording Information Test Bank—Medical MULTIPLE CHOICE 1. If information is purposefully omitted from the record, you should a. erase the notes that are not pertinent. b. never explain the emission. c. state in the record why the information was omitted. d. use correction fluid to omit the information. e. know that only helpful data are recorded. ANS: C
Any deferred or omitted portion of the patient record requires proper documentation that documents this occurrence along with a rationale for doing so. REF: p. 616
TOP: Discipline: Behavioral Science
MSC: Organ System: General
2. Which part of the information contained in the patient’s record may be used in court? a. Subjective information b. Objective information c. Diagnostic information d. Consultations e. All information ANS: E
Anything that is entered into a patient’s record, in paper or electronic form, is a legal document and can be used in court. REF: p. 616
TOP: Discipline: Behavioral Science
MSC: Organ System: General
3. During the course of the interview, you should a. take no notes of any kind. b. take brief written notes. c. take detailed written notes. d. repeat pertinent comments into a Dictaphone. e. interrupt the interview to formulate your thoughts. ANS: B
During the interviewing process, it is important to maintain eye contact with the patient and to spend as little time as possible looking at your notes, so brief written notes are more practical. Later you can go back and formulate a well-versed history by linking all the pieces together. REF: p. 616
TOP: Discipline: Behavioral Science
MSC: Organ System: General
4. Ms. S reports that she is concerned about her loss of appetite. During the history, you learn
that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S’s loss of appetite, it would be better to a. defer or omit her comments. b. have her husband call you.
c. quote her concerns verbatim. d. refer her for psychiatric treatment. e. record your interpretations. ANS: C
It is best to document what you observe and what is said by the patient rather than document your interpretations. Listening and quoting exactly what the patient says is the best rule to follow; there is no indication that you should refer her or clarify with her husband. REF: p. 621
TOP: Discipline: Behavioral Science
MSC: Organ System: General
5. Subjective and symptomatic data are a. documented in your assessment. b. not mentioned in the legal chart. c. placed in the history sections. d. recorded with the examination technique. e. documented with the findings. ANS: C
Subjective data, as well as symptomatic data, should not be part of the physical examination findings; rather, their documentation is appropriate for the history portion. REF: p. 616
TOP: Discipline: Behavioral Science
MSC: Organ System: General
6. The quality of a symptom, such as pain, is subjective information that should be a. deferred until the cause is determined. b. described in the history using a 1-to-10 scale. c. placed in the past medical history section. d. placed in the history with objective data. e. interpreted in light of your physical findings. ANS: B
Pain is subjective, and only the patient can rate the perceived severity. Pain, therefore, should be recorded the history using a 1-to-10 scale. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
7. Which of the following is an effective adjunct to document location of findings during
recording of physical examinations? a. Relationship to anatomic landmarks b. Computer graphics c. Comparing with other patients of same gender and size d. Comparing to previous examinations using light pen markings e. Scale drawings specific to the patient ANS: A
Abnormal or normal findings are best described in relationship to universal topographic and anatomic landmarks. REF: p. 618
TOP: Discipline: Behavioral Science
MSC: Organ System: General
8. The position on a clock, topographic notations, and anatomic landmarks
a. b. c. d. e.
are methods for recording locations of findings. are used for noting disease progression. are ways for recording laboratory study results. are usually misinterpreted. should not be used in the legal record.
ANS: A
Descriptions of the locations of findings are universally referenced by using positions on a clock, topographic notations, or anatomic landmarks. REF: p. 618
TOP: Discipline: Behavioral Science
MSC: Organ System: General
9. Regardless of the orifice, discharge is described by noting a. only the amount. b. color and consistency. c. demographic data and risk factors. d. associated symptoms in alphabetic order. e. a grading scale of 0 to 4. ANS: B
No matter where the origin of the discharge is, color and consistency determine whether it is an expected finding. REF: p. 619
TOP: Discipline: Behavioral Science
MSC: Organ System: General
10. Drawing of stick figures is most useful to a. compare findings in the extremities. b. demonstrate radiation of pain. c. indicate organ enlargement. d. indicate mobility of masses. e. indicate consistency of lymph nodes. ANS: A
Simple drawings, such as stick figures, are more practical illustrations for findings in the extremities. Radiation of pain, organ enlargement, consistency of lymph nodes, and mobility of masses would not be adequately described by such simple drawings. REF: p. 619
TOP: Discipline: Behavioral Science
MSC: Organ System: General
11. Which of the following is an example of a problem requiring recording on the patient’s
problem list? a. Common age variations b. Expected findings c. Findings of unknown origin d. Minor variations e. Only findings that have a clear etiology ANS: C
Any problem is worth noting on the patient problem list even if the etiology or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as problems.
REF: p. 619
TOP: Discipline: Behavioral Science
MSC: Organ System: General
12. A problem may be defined as anything that will require a. evaluation. b. medication. c. surgery. d. treatment. e. referral. ANS: A
The need for further evaluation or attention indicates a problem. If a problem is found, it does not necessarily warrant medication, surgery, treatment, or referral. REF: p. 619
TOP: Discipline: Behavioral Science
MSC: Organ System: General
13. Differential diagnoses belong in the a. history. b. physical examination. c. assessment. d. plan. e. laboratory data. ANS: C
Differential diagnoses for problems that have not been diagnosed are placed in the assessment category for each problem. The differentials are prioritized, and contributing factors are identified. REF: p. 620
TOP: Discipline: Behavioral Science
MSC: Organ System: General
14. When recording assessments during the construction of the problem-oriented medical record,
the examiner should a. combine all data into one assessment. b. create an assessment for each problem on the problem list. c. create an assessment for every abnormal physical finding. d. create an assessment for every symptom presented in the history. e. create an assessment for each abnormal laboratory finding. ANS: B
After the examiner has a list of problems constructed, then an assessment is made for each unique problem. REF: p. 620
TOP: Discipline: Behavioral Science
MSC: Organ System: General
15. Which of the following is not a characteristic of the plan portion of the problem-oriented
medical record? a. A plan is developed for each problem. b. Therapeutics c. Patient education d. Differential diagnosis e. Diagnostics ordered ANS: D
Develop a plan for each problem on the problem list. A differential diagnosis is part of the assessment phase. Diagnostics ordered, therapeutics, and patient education are all part of the plan related to the diagnosis given. REF: p. 620
TOP: Discipline: Behavioral Science
MSC: Organ System: General
16. Your patient returns for a blood pressure check 2 weeks after a visit during which you
performed a complete history and physical examination. This visit would be documented by creating a(n) a. progress note. b. incident report. c. problem-oriented medical record. d. triage note. e. new problem list. ANS: A
A second visit with the clinician is always recorded on a progress note, noting any updates to the condition. REF: p. 621
TOP: Discipline: Behavioral Science
MSC: Organ System: General
17. A detailed description of the symptoms related to the chief complaint is presented in the a. history of present illness. b. differential diagnosis. c. assessment. d. general patient information section. e. past medical history. ANS: A
The signs and symptoms and historical data of the patient’s experience that lead up to the chief complaint is placed in the history of present illness. REF: p. 621
TOP: Discipline: Behavioral Science
MSC: Organ System: General
18. The effect of the chief concern on the patient’s lifestyle is recorded in which section of the
medical record? a. Chief complaint b. History of present illness c. Past medical history d. General patient information e. Social history ANS: B
The effect of the patient’s complaint on his or her current everyday lifestyle or work performance is recorded in the history of present illness. REF: p. 621
TOP: Discipline: Behavioral Science
MSC: Organ System: General
19. The patient’s perceived disabilities and functional limitations are recorded in the a. problem list. b. general patient information. c. social history.
d. review of systems. e. past medical history. ANS: E
Past medical history contains information about the patient’s lifetime as well as disabilities or functional limitations that alter activities of daily living. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
20. The review of systems is a component of the a. physical examination. b. health history. c. assessment. d. past medical and surgical history. e. personal and social history. ANS: E
Review of systems relates health history according to physical systems and is related just before the actual physical examination. REF: pp. 621-622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
21. Allergies to drugs and foods are generally listed in which section of the medical record? a. General patient information b. Past medical history c. Social history d. Problem list e. History of present illness ANS: B
The past medical history section contains information such as drugs, foods, and environmental allergies. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
22. Ms. G is being seen for her routine physical examination. She is a college graduate and
president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G’s _____ history. a. identifying information b. past medical c. personal and social d. present problem e. family ANS: C
The information such as education and economic condition are part of the personal and social history. It is not family data, nor does it contain any specific past medical information. Identifying information is usually limited to the name, date of birth, and assigned history number. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
23. Objective data are usually recorded a. by body systems. b. in the history. c. subsequent to the assessment and plan. d. before the health history. e. in the problem list. ANS: A
All objective data are recorded by body systems and anatomic locations. REF: p. 624
TOP: Discipline: Behavioral Science
MSC: Organ System: General
24. Information recorded about an infant differs from that of an adult, mainly because of the
infant’s a. attention span. b. developmental status. c. nutritional differences. d. source of information. e. limited past medical history. ANS: B
The organizational structure of an infant’s record is different because the infant’s current and future health are referenced in terms of developmental status. REF: p. 626
TOP: Discipline: Behavioral Science
MSC: Organ System: General
25. In which section of the newborn history would you find details of gestational assessment and
extrauterine adjustment data? a. Family b. General patient information c. Personal and social d. Present problem e. Past medical ANS: D
For a newborn, the focus of recorded information is the details of the mother’s pregnancy, the gestational development, and events occurring since birth. These data are recorded in the present problem section of the history. REF: p. 626
TOP: Discipline: Behavioral Science
MSC: Organ System: General
26. What finding is unique to the documentation of a physical examination of an infant? a. Fontanel sizes b. Liver span c. Prostate size d. Thyroid position e. Visual acuity ANS: A
The size and characteristic of the fontanel are unique and important in the assessment of an infant. Data on liver span, prostate size, thyroid position, and visual acuity are adult assessment findings.
REF: p. 626
TOP: Discipline: Behavioral Science
MSC: Organ System: General
27. Data relevant to the social history of older adults include information on a. family support systems. b. extra time to assume positions. c. over-the-counter medication intake. d. date of last cancer screening. e. previous health care visits. ANS: A
The social history of older adults includes community and family support systems. Health care visits, medications, cancer screenings, and extra time to assume positions for the physical examination are not part of the social history. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
28. A SOAP note is used in which type of recording system? a. Preventive care b. Pedigree c. Systems review d. Traditional treatment e. Problem oriented ANS: E
A SOAP note, which includes subjective problem data, objective problem data, assessment, and plan, is a type of recording system that has a problem-oriented style. REF: p. 618
TOP: Discipline: Behavioral Science
MSC: Organ System: General
29. The examiner’s evaluation of a patient’s mental status belongs in the a. history of present illness. b. review of systems. c. physical examination. d. patient education. e. problem list. ANS: C
Mental status assessment, including cognitive and emotional stability and speech and language, are part of the physical examination. REF: p. 625
TOP: Discipline: Behavioral Science
MSC: Organ System: General
30. When recording physical findings, which data are recorded first for all systems? a. Review of systems b. Percussion c. Palpation d. Auscultation e. Inspection ANS: E
Physical assessment for all systems begins with inspection.
REF: p. 618
TOP: Discipline: Behavioral Science
MSC: Organ System: General
31. Regarding another provider’s documented work, it a. is not relevant in a legal proceeding. b. will not affect clinical decisions. c. may be copied verbatim into your documentation. d. must be attributed to the source if entered. e. does not affect patient care. ANS: D
It is unacceptable to copy other providers’ documented work (e.g., history taken, examination performed, or thought processes outlined) and enter it into your own documentation as if you did the work. Text copied from another person’s note must always be attributed to the source. This is not only an important concept in a legal proceeding, but it is also critical for safe patient care. REF: p. 616
TOP: Discipline: Behavioral Science
MSC: Organ System: General
32. Which of the following is true regarding the use of “copy and paste, carry forward” (CPCF) in
an electronic medical record? a. It is never acceptable. b. It can decrease efficiency. c. It increases the chance of information drop-off. d. It may be used on medication lists. e. It increases the chance of typing errors. ANS: D
Although text replication is generally discouraged, it can improve efficiency, decrease information drop-off, and decrease typing errors, and thus there may be some uses that are potentially acceptable. Copying and pasting important lists or information (e.g., medication lists) can prevent potential clinically relevant retyping errors. REF: p. 617
TOP: Discipline: Behavioral Science
MSC: Organ System: General
33. The OLDCHARTS mnemonic is a way of documenting which of the following? a. History of present illness b. Past medical history c. Family history d. Social history e. Review of systems ANS: A
The OLDCHARTS mnemonic helps make sure all characteristics of a problem are described in the history of present illness to ensure a comprehensive presentation. The order of recording these characteristics does not need to be consistent. REF: p. 622
TOP: Discipline: Behavioral Science
MSC: Organ System: General
Chapter 27: Emergency or Life-Threatening Situations Test Bank—Medical MULTIPLE CHOICE 1. The deepest level of coma determined by the Glasgow Coma Scale is a value of a. 0. b. 1. c. 2. d. 3. e. 4. ANS: D
This tool allows numeric scoring of the patient’s verbal, motor, and eye opening responses to specific stimuli to assess the cerebral cortex and brainstem function. The patient’s best response in each category is matched to the criteria for scoring. The lowest score in each category is 1. REF: p. 634
TOP: Discipline: Pathophysiology
MSC: Organ System: General
2. You arrive by ambulance at a construction site, where a man is lying on the street. The only
information you have is that he fell three stories. His neck is immobilized with sacks of concrete mix on either side. Your first action should be to determine a. airway patency. b. bleeding sites. c. cranial nerve function. d. limb position. e. peripheral pulses. ANS: A
Upon arriving to the site, the patency of the upper airway is the priority and should be managed before proceeding with further assessments. REF: p. 633
TOP: Discipline: Pathophysiology
MSC: Organ System: General
3. The ABCs of the advanced cardiac life support survey would be interrupted to a. obtain further historical data. b. manage life-threatening conditions. c. reassess the patient’s temperature. d. transport the patient via airlift. e. complete the assessment record. ANS: B
As with the serious injuries the advanced cardiac life support survey is interrupted to manage a life-threatening physiologic condition as soon as it is detected. REF: p. 637
TOP: Discipline: Pathophysiology
4. Status epilepticus is defined as a. seizures with intermittent recovery of consciousness.
MSC: Organ System: General
b. c. d. e.
nonconvulsive brain wave disturbance with psychomotor dysfunction. protracted convulsions with unresponsiveness lasting up to an hour. seizures that result in hypotension, pallor, and prolonged diaphoresis. convulsive activity uncontrolled by medication.
ANS: C
Status epilepticus is characterized by seizures that are protracted and recurrent without recovery of consciousness and that can be prolonged for as long as 60 minutes. REF: p. 644
TOP: Discipline: Pathophysiology
MSC: Organ System: Nervous
5. Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats/min, and
increasing dyspnea are signs of a. intracranial pressure. b. pulmonary hypertension. c. status asthmaticus. d. tetanic contractions. e. drug overdose. ANS: C
Status asthmaticus is a severe and prolonged asthma attack that resists usual therapeutic approaches. The patient experiences dyspnea, can only get out a few words between breaths, and has tachycardia often more than 130 beats/min and pulsus paradoxus greater than 20 mm Hg. Pulsus paradoxus is more likely in pericardial effusion, constrictive pericarditis, and severe asthma. REF: p. 644 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 6. Cushing triad includes a. hypotension. b. irregular respirations. c. tachypnea. d. constricted pupils. e. tachycardia. ANS: B
Cushing triad is associated with increased intracranial pressure. Cushing triad includes bradycardia, hypertension, and irregular respirations, even Cheyne-Stokes respirations. REF: p. 643
TOP: Discipline: Neuroscience
MSC: Organ System: Nervous
7. Blood, vomitus, or foreign bodies are removed from the oropharynx of the unconscious
patient by a. stimulating the cough reflex. b. placing the patient prone. c. performing a back thrust. d. using suction. e. hyperextending the neck. ANS: D
Suction is used to remove blood, vomitus, or foreign bodies from the airway of an unconscious patient. The other choices put the patient at risk for aspiration or further injury if a neck injury is involved. REF: p. 632
TOP: Discipline: Pathophysiology
MSC: Organ System: General
8. While you are performing the primary survey on a trauma victim, the patient is answering
your questions. You may assume that during the time of the questioning a. his airway is open. b. he is alert and oriented. c. no head injury has occurred. d. there is no respiratory compromise. e. he is not hypovolemic. ANS: A
The patency of the upper airway is assessed at the start by asking the patient a question. If the patient answers, it is a sign that the airway is open at this time. The ability to speak may not ensure orientation or alertness, nor does it ensure lack of a head injury, respiratory compromise, or hypovolemia. REF: p. 632
TOP: Discipline: Pathophysiology
MSC: Organ System: General
9. If trauma above the clavicle is suspected, it is important to a. perform endotracheal intubation. b. test range of motion of the neck. c. arrange for neck extension x-ray studies. d. stabilize the neck in a neutral position. e. remove any headgear. ANS: D
If trauma above the clavicle is suspected, it is important to control the cervical spine by stabilizing the neck in a neutral position. Excessive movement can convert a fracture or dislocation without neurologic damage to one with neurologic damage. REF: p. 632
TOP: Discipline: Neuroscience
MSC: Organ System: General
10. Paradoxic chest movement suggest a a. spontaneous pneumothorax. b. status asthmaticus. c. clavicle fracture. d. pulmonary contusion. e. flail chest. ANS: E
Paradoxic chest movement is associated with fractured ribs or a flail chest. This fracture should be stabilized immediately. REF: p. 632 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 11. Respiratory distress may be evidenced by a. retractions of accessory muscles.
b. c. d. e.
oliguria. flushed skin. decreased capillary refill time. bradycardia.
ANS: A
Respiratory distress results in an increased intrathoracic negative pressure as the body attempts to suck in more atmospheric air. This increased negative pressure causes the chest wall skin to retract around the ribs during inspiration. The other choices are related to cardiovascular distress. REF: p. 632 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 12. Upon palpating the chest wall of a trauma patient, you feel subcutaneous crepitus
(emphysema), which is a sign that a. there is a flail chest. b. a fracture underlies the injury. c. a foreign body is present. d. there is vascular obstruction. e. air has leaked into soft tissue. ANS: E
Crepitus is a sign of air leakage into soft tissue. Crepitus in soft tissues is caused by air that has penetrated the area as a result of injury and is also referred to as subcutaneous emphysema. A flail chest need not be present. Bony crepitus is a grating or grinding sensation caused by fractured bone ends or joints rubbing together. A foreign body could obstruct the patient’s airway, producing stridor, or a bark may be heard with an obstructed airway. REF: p. 633 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 13. Clear or amber drainage from the nose or ears of a patient who has sustained blunt trauma
may indicate a. epiglottitis. b. aspiration. c. basilar skull fracture. d. perforated tympanic membrane. e. retropharyngeal abscess. ANS: C
Clear or amber drainage from the nose or ears may indicate a basilar skull fracture. Epiglottitis and retropharyngeal abscess will result in airway obstruction, and aspiration will result in hypoxemia. A perforated tympanic membrane will have bloody drainage. REF: p. 635
TOP: Discipline: Pathophysiology
14. Delayed capillary refill may alert you to a. hypovolemic shock. b. moderate hypoxemia. c. epiglottitis.
MSC: Organ System: General
d. upper respiratory infection. e. subnormal intracranial pressure. ANS: A
Delayed capillary refill means that the vessels are taking an extended time to fill, which is a sign of decreased cardiac output. To further assess peripheral perfusion and detect hypovolemic shock, note the skin color, presence and quality of pulses, and temperature of the extremities. REF: p. 643 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 15. Capillary refill can be assessed by applying pressure over a nail bed or a(n) a. bony prominence. b. ear. c. mucous membrane. d. femoral vein. e. eyelid. ANS: A
Capillary refill can be assessed by pressing firmly over a nail bed or bony prominence, such as the chin, forehead, or sternum, until the skin blanches. Count the seconds it takes for color to return. Less than 2 seconds is a normal finding, and longer than 2 seconds indicates poor perfusion. REF: p. 634 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 16. You would complete a Glasgow Coma Scale rating during the a. health history. b. physical examination. c. primary survey. d. secondary survey. e. patient transport. ANS: C
During the primary assessment, a brief neurologic evaluation is performed to identify significant disability. Assess the patient’s level of consciousness with the Glasgow Coma Scale. REF: p. 634
TOP: Discipline: Pathophysiology
17. Raccoon eyes and Battle sign are associated with a. a ruptured spleen. b. orbital fractures. c. basilar skull fractures. d. subdural hematoma. e. ectopic pregnancy. ANS: C
MSC: Organ System: General
Bruising around the eyes (raccoon eyes) or behind the ears (Battle sign) both indicate a basilar skull fracture. Symptoms of orbital fractures are swelling of the eyelid, bruising of the eye, pain in the eye, double vision, and decreased movement of the affected eye. Signs and symptoms of a subdural hematoma are loss of consciousness after original injury, steady or fluctuating headache, weakness, numbness or inability to speak, slurred speech, nausea, vomiting, lethargy, and seizures. REF: p. 635
TOP: Discipline: Pathophysiology
MSC: Organ System: General
18. A life-threatening condition is recognized with the assessment of a. pain with downward pressure on both anterior superior iliac spines. b. guarding and intense pain with deep palpation of the abdomen. c. distant and muffled heart sounds with distended neck veins. d. severe throbbing pain in one eye with photophobia. e. painful blunt sternal pressure. ANS: C
Distant, muffled heart sounds and distended neck veins may indicate cardiac tamponade, a life-threatening condition. Iliac spine pain indicates a pelvic fracture that may become life threatening depending on the extent of occult bleeding, intense pain with deep palpation is not certain to be deadly, and eye pain with photophobia signals acute glaucoma that can lead to blindness if treatment is delayed. Painful blunt sternal pressure would indicate a sternal or rib fractures, which are not necessarily life threatening. REF: p. 635
TOP: Discipline: Pathophysiology
MSC: Organ System: General
19. The application of blunt sternal pressure is used to detect a. fracture of attached ribs. b. motor function of T7 dermatome. c. cardiac tamponade. d. cardiac contusion. e. pneumothorax. ANS: A
Blunt sternal pressure is painful if any attached ribs are fractured. The sternal pressure is applied to the chest to assess the stability of the chest wall. REF: p. 635
TOP: Discipline: Pathophysiology
MSC: Organ System: General
20. Until stabilized, trauma patients require reevaluation every a. 2 minutes. b. 5 minutes. c. 10 minutes. d. 15 minutes. e. hour. ANS: B
An unstable patient must be reevaluated frequently so that any new signs and symptoms are not overlooked. A primary survey should be performed every 5 minutes and the results compared with those obtained in previous surveys.
REF: p. 636
TOP: Discipline: Pathophysiology
MSC: Organ System: General
21. During injury assessment, one of the most crucial historical components is a. number of siblings. b. history of prior fractures. c. mechanism of injury. d. past and current occupational exposures. e. personal and social history. ANS: C
In cases of trauma, the secondary assessment is intended to identify the full range of injuries, with particular focus on body systems affected by the mechanism of injury. All of the other choices are not crucial for the emergency. REF: p. 636
TOP: Discipline: Pathophysiology
MSC: Organ System: General
22. Which injury is the most common precipitator of severe blunt trauma? a. Age-related falls b. Motor vehicle accidents c. Work-related injuries d. Childhood play injuries e. Sports-related injuries ANS: B
Automobile accidents account for the majority of severe blunt trauma cases. REF: p. 637
TOP: Discipline: Pathophysiology
MSC: Organ System: General
23. Adults and children display different physiologic responses to injury and acute illness. An
important concept to remember when assessing infants and children is that they a. experience lethal arrhythmias first, progressing to respiratory failure. b. are smaller, so they are less prone to hypothermia than adults. c. usually experience respiratory arrest before circulatory failure. d. tolerate greater volume changes with less severe consequences. e. usually experience cardiac arrest before respiratory failure. ANS: C
Cardiac arrest is rarely a primary event in children as it is in adults. A child usually experiences respiratory and ventilatory failure that progresses to respiratory arrest first. Without rapid intervention, a cardiac arrest occurs as a secondary event. REF: p. 638
TOP: Discipline: Pathophysiology
MSC: Organ System: General
24. The approximate expected systolic blood pressure for a child older than 1 year of age is _____
the child’s age in years. a. 100 + b. 80 + c. 120 – d. 80 + 2 e. 120 + ANS: D
Use the equation 80 + 2 the child’s age in years to calculate the expected systolic blood pressure for a child older than 1 year. REF: p. 638 TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular 25. In life-threatening emergencies, consent for treatment a. is obtained before treatment to protect the facility from liability. b. must be obtained within an hour after beginning treatment. c. occurs after treatment is administered. d. is not valid because the patient is not competent. e. is not necessary. ANS: C
In life-threatening emergencies, the needed treatment should most often be given and formal consent obtained later. Consent usually is obtained before a planned treatment. REF: p. 641
TOP: Discipline: Pathophysiology
MSC: Organ System: General
26. The mnemonic AMPLE is used to assess a. level of responsiveness. b. respiratory status. c. secondary assessment of a trauma patient. d. level of coma. e. an abbreviated history in an emergency condition. ANS: E
AMPLE is a mnemonic that focuses on an abbreviated history relevant to an emergency condition. REF: p. 635
TOP: Discipline: Pathophysiology
MSC: Organ System: General