SEIDEL'S GUIDE TO PHYSICAL EXAMINATION. An Interprofessional Approach 9th Edition by QuentinAxel

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 01: The History and Interviewing Process Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. Which e i ld be c ide ed a leadi g e i ? a. Plea e de c ibe a a cia ed m m i h headache ? b. Y d ge headache f e , d ? c. Wha ac i i ie affec he e e i f headache ? d. Wha ime f he da a e headache he m e e e? e. Wha ie m ab headache? ANS: B

Thi e i ld limi he i f ma i i he a ie patient more discretion about the extent of an answer. TOP: Discipline: Behavioral Science

e . The

he ch ice all

MSC: Organ System: General

2. Which action would best promote accurate translations as well as confidentiality when the

ca egi e d e eak he a ie la g age? 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

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Whe d eak he a ie la g age, famil membe f ie d ma ea communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased. TOP: Discipline: Behavioral Science

MSC: Organ System: General

3. 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 a calm environment. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

4. Which ech i e i m likel e l i he a ie de a di g f a. Use phrases that are commonly used by other patients in the area. b. U e he a ie e m if ible.

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e i

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 i g he a ie idi m a d le el f de a di g. TOP: Discipline: Behavioral Science

MSC: Organ System: General

5. A a ie

c a. b. c. d. e.

bec me e le d i g he hi a d a , Id ha e ime f all of this e ai .I eg ge back k. Y m a ia e e e ld be : stop using open-ended questions and become more direct. ask another open-ended question and insist on an answer. ask questions about his anger and move closer to him. acknowledge his anger and proceed with the history and examination. ignore his displeasure and become more assertive about getting answers.

ANS: D

This is the only answer that resists the tendency for patient manipulation, pursues the i f ma i , a d c f he a ie a ge . TOP: Discipline: Behavioral Science

MSC: Organ System: General

6. Whe

e i i g a a ie ega di g alc h l i ake, he ell ha he i l a d i ke . Which i i ial e ei a ia e? a. I m glad ha a ea e ible d i ke . b. Ma e le h a e eall lic B.C a he Ma e cial d i ke . NURalc IhNG S T O d i k i a eek? c. Wha am a d ha ki d f alc h l d d. If l d i k ciall , eed ab al a ha i g a de ig a ed d i e . e. D he he e le i h eh ld c me alc h l?

cial

ANS: C

Thi a e cla ifie he a ie judgmental.

em ih

a ki g a leadi g

TOP: Discipline: Behavioral Science

MSC: Organ System: General

e i

bei g

7. 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. Ca de c ibe he ai ? b. The ai d e adia e a m, d e i ? c. Ha e bee ea ed f a ie bef e? d. D e fa he ha e hea di ea e? e. A e he ai e af e ea ? ANS: A

Initially, an open-e ded e i i a m e a ia e e e. Ca is an open-ended question that offers clues to the chief concern.

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de c ibe he ai ?

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Behavioral Science

MSC: Organ System: General

8. M . A. a e , M life i j

ai f l. I i h i . She a ea de e ed. Which of the following statements is the most appropriate caregiver response? a. T hi k ab he g d hi g i life. b. Y h ld feel ha a ; l k a all he g d hi g i life. c. Y ca mea ha e a i g. d. If hi k ab i, hi g i h ge i g hi e ab . e. Wha i life i ca i g ch ai ?

ANS: E

Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance. TOP: Discipline: Behavioral Science

MSC: Organ System: General

9. 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. Rec d he im e i i he a ie cha a d efe he a ie f hospitalization. e. Avoid directly confronting the patient regarding your impression. ANS: B

If you think the patient may be suicide, NUconsidering RSINGTB.C OMhe or she probably is. Mentioning it gives permission to talk about it. TOP: Discipline: Behavioral Science

MSC: Organ System: General

10. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

11. When communicating with older children and teenagers, you should be sensitive to their: a. a e eed . b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. desire for adult companionship. ANS: D

Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality. TOP: Discipline: Behavioral Science

MSC: Organ System: General

12. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

13. 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 you sense NURSonly INGwhen B.C M that he or she may feel T O 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

14. When taking a history, you should: a. ask patients to give you any information they can recall about their health. b. a he i e ie i h he a ie famil hi . c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. e. start the interview with the social history. ANS: C

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. S a i g he i e ie i h he a ie famil hi a d i h he cial hi a e i c ec because gathering data about the chief concern is the initial step. TOP: Discipline: Behavioral Science

MSC: Organ System: General

15. When questioning the patient regarding his or her sexual history, which question should be

asked initially? a. D ha e a a ic la e al like di like ? b. D ha e a ie c ce ega di g e life? c. H fe d ha e i e c e a d i h h m? d. D ha e a ea hi k ma ha e bee e ed a mi ed i fec i ? e. Wha e all a mi ed di ea e ha e had i he a ?

a e all

ANS: B

When approaching questioning about a sensitive area, it is recommended that the provider first ask open-e ded e i ha e l e he a ie feeli g ab he i e. TOP: Discipline: Behavioral Science

MSC: Organ System: General

16. Direct questioning about intimate partner violence in the home should be: a. a routine component of history taking with female patients. b. a ided f fea f ffe di g he ma a e. c. conducted only in cases in which there is a history of abuse. NUisRobviously M d. used only when the patient SINGTB.C beingOvictimized. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

17. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

18. When you enter the examination room of a 3-year- ld gi l,

fi d he i i g he fa he lap. She turns away from you when you greet her. Initially, your best response is to: a. screen the child for sexual abuse.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

ask the child to be seated on the examination table so you can talk to her father. explain to the child that you will not hurt her and that she will have to trust you. ask the father to persuade the child to cooperate with you. lea e he child i i g i he fa he la hile alk he fa he .

ANS: E

Interaction with children must be modified according to age and in a manner that promotes trust. TOP: Discipline: Behavioral Science

MSC: Organ System: General

19. 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 ical f ad le ce ce a d e i e T m heal h? 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

20. Pain is difficult to assess in older adults because: a. their histories are usuallyNunreliable. URSINGTB.COM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

21. A survey of mobility and activities of daily living (ADL) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. e. sexual history. ANS: B

A f c i al a e me i a a e me f a a ie m bili , e e emi m eme , household management, activities of daily living, and instrumental activities of daily living. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 22. 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). TOP: Discipline: Behavioral Science

MSC: Organ System: General

23. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

24. A pedigree diagram is drafted of obtaining: Nfor Rthe Ipurpose GTB.C U S N OM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 02: Cultural Competency Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

2. 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.

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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 p oce of adop ing ano he c l e beha io . A c om efe o a habitual activity of a group in a given situation. TOP: Discipline: Behavioral Science

MSC: Organ System: General

3. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Asking, if you are not sure, is far better than making a damaging mistake. You would not be doing your job as a professional if you deferred the examination without a reason. It is not necessary to refer a skill you are capable of performing. TOP: Discipline: Behavioral Science

MSC: Organ System: General

4. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

5. In terms of cultural communication differences, Americans are more likely to _____ than

other groups of patients. a. emphasize attitudes and feelings NURSINGTB.COM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

6. Which

e ion ha he mo po en ial fo e plo ing a pa ien health problem? a. Ho of en do o ha e a medical e amina ion? b. Wha a e o age, ace, and ed ca ional le el? c. Wha pe of mp om ha e o been ha ing? d. Wh do o hink o a e ha ing he e mp om ? e. Do o ake he bal emedie ?

c l

al belief ela ed o a

ANS: D

This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 7. A pe on 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 defini ion of ill is determined in large part by the individualand the process whereby an individual assumes the traits and behaviors of a given culture. TOP: Discipline: Behavioral Science

MSC: Organ System: General

8. An aspect of traditional Western medicine that may be troublesome to many Hispanics,

Na i e Ame ican , A ian , and A ab i We e n medicine a emp o: 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. p omo e balance in an indi id al life. ANS: B

A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, A ian , and A ab emb ace a mo e holi ic app oach. TOP: Discipline: Behavioral Science Organ NURSINGMSC: TB.C OM System: General 9. 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 bad that must be kept in balance if we are to remain well. TOP: Discipline: Behavioral Science

some good,

MSC: Organ System: General

10. 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 breast-feeds. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Behavioral Science

MSC: Organ System: General

11. 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 p po e of nde anding he pa ien c l pertinent questioning and avoid stereotyping. TOP: Discipline: Behavioral Science

e( ) i o help he p o ide con

MSC: Organ System: General

12. The attitudes of the healthcare 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 healthcare 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 healthcare professional are easily detected by others, and they influence patient behavior. N R I G B.C M

U S N T

TOP: Discipline: Behavioral Science

MSC: Organ System: General

13. All of the following are important aspects of reducing disparities in health care except: a. identify and monitor conscious and unconscious biases. b. help the patient to learn about his or her disease or condition. c. con ide he heal h li e ac of one pa ien . d. try to discuss aspects of care without the influence of friends, partner, or family

members. e. encourage patients to complete patient satisfaction and demographics forms. ANS: D

All of the above are ways a healthcare provider can reduce disparities in health care except the e cl ion of a pa ien f iend , pa ne , o famil membe . I i impo an in ed cing disparities in health care for the provider to partner with patients and families to provide high-quality care. TOP: Discipline: Behavioral Science

MSC: Organ System: General

14. Which of the following is not an aspect of cultural humility? a. Abili o ecogni e one s limitations in knowledge and cultural perspective b. Self-reflection and self-critique c. Assuming all patients of a particular culture fit a certain stereotype d. Mee ing pa ien he e he a e i ho j dgmen

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. Gen ine in e e in nde

anding o

pa ien

belief

em and li e

ANS: C

Rather than assuming all patients of a particular culture fit a certain stereotype, healthcare providers should view patients as individuals. In doing so, cultural humility helps equalize the imbalance in the patient-provider relationship. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 03: Examination Techniques and Equipment Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i 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. 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 or office settings. e. believed to have an infectious disease. ANS: D

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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 or outpatients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered. TOP: Discipline: Pathophysiology

MSC: Organ System: General

3. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

4. Which patient position is useful for auscultating heart tones? a. Lithotomy

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

Dorsal recumbent Left lateral recumbent Right Sims 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

5. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

6. You are conducting a head to toe e amination 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 assume M while conducting this examination? NUshould RSINyou GTB.C O 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 conventionall taught to approach an e amination 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

7. Which part of the e aminer 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: General

8. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

9. 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 heardOover NURStones INGare M the liver. TB.C TOP: Discipline: Pathophysiology

MSC: Organ System: General

10. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

11. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The dominant hand s middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. TOP: Discipline: Pathophysiology

MSC: Organ System: General

12. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

13. 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. N R I G B.C M

U S N T

TOP: Discipline: Pathophysiology

MSC: Organ System: General

14. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

15. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

16. A scale used to assess a patient s eight 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

17. An infant should be placed in which position to have his or her height or length measured? a. Vertical, ith the e aminer s hands under the infant s a illa b. Supine on a measuring board c. While being held by a parent d. In the lateral position with the toes a measuring board NU RS INagainst GTB.C M O e. Prone on a measuring board ANS: B

An infant should be placed supine on a measuring board to measure height or length. TOP: Discipline: Pathophysiology

MSC: Organ System: General

18. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

19. Which of the following occurs when firm pressure is used to appl the stethoscope s bell

endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

20. Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of

stethoscope? a. Diaphragm end of an acoustic stethoscope b. Electronic c. Ultrasonic d. Magnetic e. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

21. 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? NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

22. Which t pe of speculum should be used to e amine a patient s t mpanic 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Pathophysiology

MSC: Organ System: General

23. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

24. 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. TOP: Discipline: Pathophysiology N R

MSC: Organ System: General U SINGTB.COM

25. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

26. Transillumination functions on the principle that: a. infrared radiation is easily detected. 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. e. air, fluid, and tissue transmit light differentially. ANS: E

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

27. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

28. 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. NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 04: Clinical Reasoning Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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 a problem list problems as specifically as possible. Identify and list the signs and m m a cia ed i h each f a ie c ce a ell a ab mali ie di c e ed during the physical examination. TOP: Discipline: Behavioral Science

MSC: Organ System: General

2. 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. all ed he i g . ANS: A

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New findings of unknown causes are added to the problem list, but do not let them become a ed he i g ha di ac a e i f m he ce al i e . TOP: Discipline: Behavioral Science

MSC: Organ System: General

3. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

4. Medical decision making requires a balance between: a. speculation and feelings. b. opinions and beliefs.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. knowledge and superstition. d. Mechanism and probability. e. trust and suspicion. ANS: D

Medical decision making must have a balance between mechanism and probability (certainty in knowledge is impossible). TOP: Discipline: Behavioral Science

MSC: Organ System: General

5. 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. High specificity suggests the ability of an observation to identify correctly those who do not have the disease. TOP: Discipline: Biostatistics

MSC: Organ System: General

6. 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 the disease. NUR INhave GTB.C S OM c. be exclusively used to make a diagnosis. d. suggest the presence of a disease that is not present. 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. TOP: Discipline: Biostatistics

MSC: Organ System: General

7. 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. TOP: Discipline: Biostatistics

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 8. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

9. 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. ig e he a ie cial a d ec mic ci c m a ce . d. address the most urgent problem first. e. e e c ide if he c f ca e ill im ac he a ea f he a ie

life.

ANS: D

In developing patient care plans, priority should be given to the most life threatening and ge h ical eed f he a ie . The f c add e i g he a ie cial a d economic circumstances and whether the cost of care will impact other areas f he a ie life.

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TOP: Discipline: Behavioral Science

MSC: Organ System: General

10. 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 probability 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

11. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Behavioral Science 12. The e m de i g he ca egi e a. autonomy. b. deontologic imperative. c. nonmaleficence. d. utilitarianism. e. beneficence.

MSC: Organ System: General

eed

ha m

he a ie

ANS: C

The definition of nonmaleficence is to do no harm. TOP: Discipline: Behavioral Science 13. Which of the following is initially a

MSC: Organ System: General

ia e i

he ma ageme

f a a ie

diag

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

N R I G B.C M

N Th ld Oall f he g ea e a ie a A i i ial a ach a a ie U S blem m a d 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 05: Documentation Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

2. 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

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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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

3. 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 0 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 in the history using a 0 to 10 scale. TOP: Discipline: Behavioral Science

MSC: Organ System: General

4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

5. Which of he follo ing is an e ample of a problem req iring recording on he pa ien 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

6. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. NURSINGTB.COM d. plan. e. laboratory data. ANS: C

MSC: Organ System: General

7. 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, an assessment is made for each unique problem. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 8. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

9. The effec of he chief concern on he pa ien s lifes le is recorded in

hich sec ion of he

medical record? a. Chief complaint b. History of present illness c. Past medical history d. General patient information e. Social history ANS: B

The effec of he pa ien s complain on his or her c rren e er da lifes le or ork performance is recorded in the history of present illness. TOP: Discipline: Behavioral Science Organ NURSINGMSC: TB.C OM System: General 10. The pa ien 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

Pas medical his or con ains informa ion abo he pa ien s life ime as ell as disabili ies or functional limitations that alter activities of daily living. TOP: Discipline: Behavioral Science

MSC: Organ System: General

11. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Behavioral Science

MSC: Organ System: General

12. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

13. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

N R I G B.C M

S differs N T fromOthat of an adult, mainly because of the 14. Information recorded about anU infant infan s: a. attention span. b. developmental status. c. nutritional differences. d. source of information. e. limited past medical history. ANS: B

The organi a ional s r c re of an infan s record is differen beca se he infan s c rren and future health is referenced in terms of developmental status. TOP: Discipline: Behavioral Science

MSC: Organ System: General

15. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank For a ne born, he foc s of recorded informa ion is he de ails of he mo her s pregnanc , he gestational development, and events occurring since birth. These data are recorded in the present problem section of the history. TOP: Discipline: Behavioral Science

MSC: Organ System: General

16. 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 healthcare visits. ANS: A

The social history of older adults includes community and family support systems. Healthcare visits, medications, cancer screenings, and extra time to assume positions for the physical examination are not part of the social history. TOP: Discipline: Behavioral Science

MSC: Organ System: General

17. 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

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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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

18. The e aminer s e al a ion of a pa ien s men al s a s belongs in he: 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, is part of the physical examination. Anything subjective is part of the review of s s ems and hose findings ha are objec i e are par of he pro ider s assessmen . TOP: Discipline: Behavioral Science

MSC: Organ System: General

19. When recording physical findings, which data are recorded first for all systems? a. Review of systems b. Percussion c. Palpation d. Auscultation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. Inspection ANS: E

Physical assessment for all systems begins with inspection. TOP: Discipline: Behavioral Science

MSC: Organ System: General

20. Regarding ano her pro ider s doc men ed ork, i : 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

I is naccep able o cop o her pro iders doc men ed ork (e.g., his or taken, examination performed, or thought processes outlined) and enter it into your own documentation as if you did he ork. Te copied from ano her person s no e m s al a s be a rib ed o he so rce. This is not only an important concept in a legal proceeding, but it is also critical for safe patient care. TOP: Discipline: Behavioral Science

MSC: Organ System: General

21. Which of the following abbreviations is approved by The Joint Commission on Accreditation

of Hospitals? a. U (unit) b. qd (daily) c. MS (morphine sulfate) d. All of the above e. None of the above

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ANS: B

The Join Commission has iden ified impro ing comm nica ions among caregi ers as a pa ien safe goal. Cer ain abbre ia ions ha e been placed on a do no se lis hen an error in misreading the abbreviation could cause harm. All of the above abbreviations are on he do no se lis . TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 06: Vital Signs and Pain Assessment Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

2. Which of the following is not involved in increasing body temperature? a. Exogenous 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. NURSINGTB.COM TOP: Discipline: Pathophysiology

MSC: Organ System: General

3. 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 a long-term pain associated with damage or dysfunction of the central or peripheral nervous system (e.g., amputation, complex pain syndrome). TOP: Discipline: Pathophysiology

MSC: Organ System: General

4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

5. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

6. A 5-year-old is complaining of nondescripti e bell pain. Your ne t 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 NURworse. SINGTB.COM e. allo 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

7. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

8. The value of the use of scales for patients to rate their pain intensity is that: a. the emotional responses are factored in.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

correlation ith others e pectations is achie ed. the patient s response to therapy can be documented. subjective responses are eliminated. the patient s perception is minimi ed.

ANS: C

The use of scales permits the very important day-to-day documentation of the response to therap . Although the patient s perception is the controlling variable, the patient is still giving a subjective measurable response. TOP: Discipline: Behavioral Science

MSC: Organ System: General

9. A pain scale that is reliable and valid for children is the: a. pain-o-meter scale. b. pain-rating instrument scale. c. numeric pain intensity scale. d. Wong/Baker Faces Rating Scale. e. descriptive pain intensity scale. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

10. Which is the most reliable indicator of a patient s pain? a. Facial grimacing b. Grunting or groaning NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

11. 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 ne born s pulse rate is more variable than that of toddlers, adolescents, and older adults. The variation is greatest around the time of birth and is even more marked in premature infants. TOP: Discipline: Pathophysiology

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 12. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

13. 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.

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TOP: Discipline: Pathophysiology

MSC: Organ System: General

14. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

15. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

16. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

17. The most frequent cause of serious hypertension in children is: a. malnutrition. b. liver failure. c. renal disease. d. rheumatic fever. NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

18. Systolic hypertension in the adult less than 60 years of age 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 s stolic blood pressure should be less than 120 + the patient s age is no longer the acceptable definition. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 19. The risk of hypertension in children is about four times higher for those with BMI (body mass

index) more than: a. 50% b. 65% c. 75% d. 85% e. 95% ANS: D

Because of the increase in numbers of children and adolescents who are obese, primary or essential hypertension is becoming more common. The risk of hypertension is about four times higher in children at more than 85th percentile of body mass index (BMI). TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 07: Mental Status Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. 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

NURSINGTB.COM

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. 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. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 known as Parkinson disease. 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. 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 diagnoseNneurologic R I Gdisorders. B.C M

U S N T

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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

7. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

8. A state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset

refers to: a. lethargy.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

delirium. stupor. coma. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

9. 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. TOP: Discipline: Behavioral Science Organ NURSINGMSC: TB.C OM System: Nervous 10. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

11. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy due to nerve damage and loss of feeling in fingers making it difficult to hold a pencil. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

12. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

13. 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. NURSINGTB.COM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

14. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 15. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

16. 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. The other options are not structural diseases, but instead they are neurochemical imbalances. TOP: Discipline: NeuroscienceNURSINGMSC: Organ TB.C OM System: Nervous 17. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

18. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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]). TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

19. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

20. 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

NURSINGTB.COM

Having the patient explain fables, proverbs, or metaphors determines abstract reasoning skills. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

21. Expected memory skills vary with the age of the child. When testing immediate recall, a

5-year-old can be expected to repeat how many digits or words? a. 1 b. 2 c. 3 d. 4 e. 5 ANS: D

When testing immediate recall, a 4-year-old can repeat three digits or words, a 5-year-old can repeat four digits or words, and a 6-year-old can repeat five digits or words. TOP: Discipline: Behavioral Science

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 08: Growth, Measurement, and Nutrition Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. Two hypothalamic hormones control growth hormone synthesis and secretion in the anterior

pituitary gland. Growth hormone releasing hormone (GHRH) and: a. IGF-I. b. thyroid hormone. c. leptin. d. somatostatin. e. thyroid-stimulating hormone. ANS: D

Somatostatin, or growth hormone inhibiting hormone (GHIBH), inhibits the secretion of both GHRH and thyroid-stimulating hormone (TSH). TOP: Discipline: Physiology 2. Which h ei k a. Leptin b. IGF-I c. Ghrelin d. Somatostatin e. TSH

MSC: Organ System: Endocrine

a he h

ANS: C

ge h

e ?

NURSINGTB.COM

Gh eli , a e ide, k a he h ge h e, hel and influences food intake and obesity development. TOP: Discipline: Physiology

e release

MSC: Organ System: Endocrine

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 becomes more compressed, which leads to a decline in stature. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. five times the 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. TOP: Discipline: Physiology

MSC: Organ System: Hematopoietic/Lymphoid

5. Which organ(s) complete(s) 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. 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

NURSINGTB.COM

As the facial sinuses grow, the head size enlarges its surface area to accommodate this growth. TOP: Discipline: Physiology 7. Fif e ce f a i di id al a. pregnancy. b. preschool years. c. adolescence. d. early adulthood. e. older adulthood.

MSC: Organ System: General

ideal eigh i gai ed d i g:

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. TOP: Discipline: Physiology

MSC: Organ System: General

8. Sexual maturation begins earlier in girls with a higher: a. upper-to-lower segment ratio.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

arm span. head circumference. gestational age. body mass index (BMI).

ANS: E

Sexual maturation begins earlier in girls with a higher body mass index. On average, black girls enter puberty first, followed by Mexican American girls and then white girls. Sexual maturation, as measured by the onset of pubic hair development, begins earlier in black boys than white boys. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

10. Skeletal mass and organ systems double in size during: a. infancy. NURSINGTB.COM 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. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 to 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). TOP: Discipline: Physiology

MSC: Organ System: Reproductive

13. 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.

NURSINGTB.COM MSC: Organ System: Nervous

TOP: Discipline: Behavioral Science

14. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

15. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology 16. Y

h ld ea _____ months. a. 3 b. 8 c. 12 d. 18 e. 24

MSC: Organ System: Reproductive

e he child head ci c

fe e ce a e e

heal h i i

il a lea age

ANS: E

Head circumference should be measured at every visit until 2 to 3 years of age. TOP: Discipline: Physiology 17. T

MSC: Organ System: Reproductive

ea e head ci c fe e ce, he a e i occipital protuberance and the: a. supraorbital prominence. b. brow line. c. nasal bridge. d. chin. e. hairline. ANS: A

gl a

d he child head a he

NURSINGTB.COM

The ea i g a e h ld be gl a ed a d he child head a he cci i al 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

18. Be ee 5 a d 24 h f life, he i fa che ci c fe e ce i all : 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

Be ee he age f 5 h a d 2 ea , he i fa che ci c fe e ce h ld cl el approximate the head circumference; the ratio should be monitored so that microcephaly can be identified, if present. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 19. I cli ical ac ice, he Balla d A e a. length. b. weight. c. lung maturity. d. gestational age. e. future IQ.

a e

a e b

ANS: D

The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics, ad i i e ed i hi 36 h f bi h, c fi he e b ge a i al age. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

20. The term large for gestational age (LGA) indicates that an infant is larger than ____% of

i fa b a. 10 b. 25 c. 50 d. 75 e. 90

a he a e

f eek ge a i

ANS: E

LGA corresponds to an infant who is in the greater than 90th weight percentile. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

21. The upper-to-lower segment ratio should be calculated: a. bimonthly for the first year NUofRlife. SINGTB.COM b. annually for the first 5 years. c. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

22. 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

A a ha i g ea e ha a child heigh i a cia ed i h Ma fa d e. The e children can have cardiovascular problems and should be thoroughly evaluated with a cardiologist consult.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

23. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

24. At what age does peak height growth velocity occur in boys? a. 6 years b. 10 years c. 12 years d. years e.

years

ANS: D

Peak height velocity occurs at an average age of TOP: Discipline: Physiology

years.

NURSINGMSC: TB.C OM System: Musculoskeletal Organ

25. 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. TOP: Discipline: Physiology

MSC: Organ System: Endocrine

26. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Physiology

MSC: Organ System: Reproductive

27. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

28. A woman with a normal prepregnancy body mass index (BMI) should gain around _____

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. TOP: Discipline: Physiology N

MSC: Organ System: Reproductive URSINGTB.COM

29. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Endocrine

30. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank These are all commonly associated characteristics of Cushing syndrome, with the buffalo hump as a distinguishing feature. TOP: Discipline: Pathophysiology

MSC: Organ System: Endocrine

31. Which f he f ll i g i he acc a e eflec i f a i di id al a. 24-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assays e. C a i g he i di id al i ake i h he M Pla e.g eb i e.

d i ake?

ANS: B

A food diary is recorded as it happens, making this method the most accurate reflection of an i di id al f d i ake. TOP: Discipline: Physiology

MSC: Organ System: General

32. 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 N BR12, IandGvitamin B.CD.M

U S N T

TOP: Discipline: Physiology

MSC: Organ System: General

33. M i i g a a ie ai -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. TOP: Discipline: Physiology

MSC: Organ System: General

34. Which of the following is a macronutrient? a. Iron b. Thiamin c. Calcium d. Fat e. Alcohol ANS: D

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: General

35. Which of the following hormones has a key role in regulating body fat mass and is believed to

be a trigger for puberty? a. Insulin-like growth factor I (IGF-I) b. Leptin c. Growth hormone d. Somatostatin e. Ghrelin ANS: B

Leptin has a key role in regulating body fat mass, and its concentration is thought to be a trigger for puberty by informing the central nervous system that adequate nutritional status and body fat mass are present to support pubertal changes and growth. TOP: Discipline: Pathophysiology

MSC: Organ System: Endocrine

36. 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. Refusal to maintain body weight at 85% of ideal body weight. d. Patients may abuse laxatives and diuretics. NURSINGTB.COM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

37. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

38. What percentage of adults over age 20 are estimated to be obese in the United States? a. 10% b. 25% c. 33%

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. 50% e. 66% ANS: C

In the United States it is estimated that more than one-third of adults older than 20 years are obese and more than two-thirds are overweight. Poor diet and physical inactivity (regardless of weight status) are associated with serious chronic diseases including type 2 diabetes, hypertension, cardiovascular disease, osteoporosis, and some types of cancer. TOP: Discipline: Behavioral Science

MSC: Organ System: General

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 09: Skin, Hair, and Nails Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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 i i e ce ha e a a id a e f e a dc a e e a , he eb e ab i g he skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition. 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

NURSINGTB.COM

The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

3. 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. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

4. Which structure is the site of new nail growth? a. Cuticle b. Paronychium c. Eponychium d. Nail bed

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

5. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

6. 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. N R I G B.C M

U S N T

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. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

7. 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. i c ea ed e i a hai f ic e he ag f e ea . 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. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

8. Brittle nails are typical findings in: a. adolescents. b. infants. c. pregnant patients.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

9. 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. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

10. 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. N R I G B.C

U S N T

ANS: B

Fair-skinned persons with light-colored eyes and repeated trauma or skin irritation have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

11. 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. i gaW d a . e. using a pen light. ANS: C

Daylight provides the best illumination source for determining color variations of the skin. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

12. Unusual white areas on the skin may be caused by: a. adrenal disease. b. polycythemia. c. vitiligo.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. Down syndrome. e. lentigo. ANS: C

The absence of melanin produces unpigmented white areas known as vitiligo. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

13. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

14. 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 historyNofR peripheral vascularMdisease I G B.C

U S N T

ANS: D

MSC: Organ System: Skin/Connective

15. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

16. Skin turgor checks are performed to determine: a. the temperature of the skin.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

hydration status. skin texture. the extent of an ecchymosis. skin moisture.

ANS: B

Skin will remain tented if the patient is dehydrated or will not tent if edema is present. TOP: Discipline: Physiology

MSC: Organ System: Skin/Connective

17. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

18. Fluorescing lesions are best distinguished using a(n): a. incandescent lamp. b. magnifying glass. c. transilluminator. NURSINGTB.COM d. W d a . e. halogen lamp. ANS: D

Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a W d a . TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

19. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 20. T a ie i g f he a ie a. menopausal women. b. newborn infants. c. pregnant patients. d. sedentary adults. e. older adults.

i i ac

i ac

fi di g i :

ANS: B

C i a a a, a temperature.

ed a ea a ce, i

TOP: Discipline: Pathophysiology

fa e b

cha ge i

MSC: Organ System: Skin/Connective

21. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

22. Cafe au lait patches are numbered with each assessment of infants and young children

because: a. their numbers are expected NUtoRincrease INGTeach B.Cyear. S OM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

23. Cherry angiomas are a common finding in: a. adults older than 30 years. b. newborns. c. pregnant patients. d. sunbathers. e. adolescents. ANS: A

Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

24. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

25. 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. TOP: Discipline: Pathophysiology N R

Organ U SINGMSC: TB.C OM System: Skin/Connective

26. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

27. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

28. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

29. 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.

N RSINGTB.COM

U TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

30. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Skin/Connective

31. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

ANS: B

The question describes is the most common form of elder abuse TOP: Discipline: Pathophysiology

physical neglect.

MSC: Organ System: Skin/Connective

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 10: Lymphatic System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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). 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

NURofSI GTB.C Lymph fluid is mostly composed aN variety of lymphocytes, minimal red blood cells, no OM platelets, and some antigens and antibodies according to its immune function. 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. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

6. 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, in older adults,M it is replaced by fat and connective tissue. N and R I G B.C

U S N T

TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

7. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

8. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

9. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

10. As adults age, their ability to resist infection decreases because of lymphatic nodes becoming

more: a. hematopoietic. b. mucoid. c. porous. d. profuse. e. fibrotic. ANS: E

Older ad l s l mph nodes diminish n mberMand si e and are replaced i h more NURSIinNbo GThB.C O fibrotic and fatty tissues. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

11. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

12. Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender e. Matted

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

ANS: D

Tenderness is almost always indicative of inflammation. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

13. Which landmark is the dividing line between the anterior and posterior cervical triangles? a. Clavicle b. Cervical spine c. Sternocleidomastoid muscle d. Sternum e. Hyoid bone ANS: C

The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

14. 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.

NURSINGTB.COM

TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

15. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

16. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

17. 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. A cyst will transilluminate; a node will not. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

18. 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. TOP: Discipline: ImmunologyN

MSC: Organ System: Hematopoietic/Lymphoid URSINGTB.COM

19. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

20. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

21. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

22. 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

MSC: Organ System: Hematopoietic/Lymphoid

23. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 24. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

25. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

NURSINGTB.COM

26. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

27. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

28. Serum sickness is usually characterized first by the appearance of: a. diffuse lymph node enlargement. b. joint pain. c. urticaria. d. fever. e. 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. TOP: Discipline: Immunology

MSC: Organ System: Hematopoietic/Lymphoid

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 11: Head and Neck Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

2. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the

_____ triangle. a. anterior b. posterior c. lateral d. medial e. ventral ANS: B

NURSINGTB.COM

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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

3. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

4. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

5. 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 apple. TOP: Discipline: Physiology N

Organ URSINGMSC: TB.C OM System: General

6. 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 12 to 15 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

7. The thyroid gland is partially obscured by the: a. cricoid cartilage. b. carotid artery. c. external jugular. d. sternocleidomastoid. e. hyoid bone.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: D

The thyroid sits just below the cricoid, an anatomic landmark for location of the thyroid; the lobes curve are somewhat hidden by the sternocleidomastoid muscle. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

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. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

9. A bruit heard over the thyroid is suggestive of: a. hypothyroidism. b. hyperthyroidism. c. thyroid cancer. d. thyroid cyst. NURSINGTB.COM e. thyroid nodule. ANS: B

MSC: Organ System: Endocrine

10. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

11. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Endocrine

12. Which is the best wa to position a patient s neck for palpation of the th roid? 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

MSC: Organ System: Musculoskeletal

13. A stethoscope is used in a head NUand RSneck INGexamination TB.COM 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: General

14. Tracheal tug suggests the presence of a(n): a. enlarged thyroid. b. swallowing disorder. c. aortic aneurysm. d. thoracic carcinoma. e. hyperparathyroidism. 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. An enlarged thyroid, swallowing disorder, hyperparathyroidism, or thoracic carcinoma would not produce a tracheal tug.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Gross Anatomy

MSC: Organ System: Pulmonary/Respiratory

15. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Endocrine

16. You are palpating a patient s th roid 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 a normal finding; NUlikely RSIN GTB.C M the right lobe of the thyroid gland is O typically 25% larger than the left and measures 4 cm. The other choices produce enlargements beyond these normal findings. TOP: Discipline: Gross Anatomy

MSC: Organ System: Endocrine

17. The most common form of birth trauma of the scalp is: a. caput succedaneum. b. cephalhematoma. c. cranial bossing. d. torticollis. e. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Skin/Connective

18. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Skin/Connective

19. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

20. When noting a bulging fontanel with marked pulsations in a 6-month-old infant, you suspect: a. normal development. b. Down syndrome. NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

21. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

22. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: General

23. 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 NUorRhyperthyroidism. associated with Graves disease SINGTB.COMMyxedema 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Endocrine

24. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 25. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

26. All of the following are recommendations of the American Academy of Pediatrics to reduce

the risk of sleep-related infant deaths including SIDS except: a. firm sleep surface. b. breast-feeding. c. routine immunizations. d. prone sleeping position. e. avoidance of tobacco smoke. ANS: D

The recommendations include supine positioning ( Back to Sleep ), use of a firm sleep surface, breast-feeding, room-sharing without bed-sharing, routine immunizations, consideration of pacifier use, as well as avoidance of soft bedding, overheating, and exposure NUillicit RSIdrugs. to tobacco smoke, alcohol, and NGTB.COM TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 12: Eyes Ball: Seidel G ide

Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

2. 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

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Term infants are hyperopic, with a visual acuity of less than 20/400. TOP: Discipline: Physiology

MSC: Organ System: Nervous

3. 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

4. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood c. Infancy d. Pregnancy e. Older adults

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

5. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

6. A condition that typically develops by the age of 45 years is: a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. e. cataracts. ANS: A

NURSINGTB.COM

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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

7. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

8. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

Retinoblastoma Oval pupils Retinal hemorrhages 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

9. 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. TOP: Discipline: Physiology NURSINGMSC: Organ TB.C OM System: Nervous 10. 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 b observing the pupil s response to light. The accommodation test deals with pupil reaction to light, and the Snellen E chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect. TOP: Discipline: Physiology

MSC: Organ System: Nervous

11. The criterion for adequac 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

12. 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

A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise. TOP: Discipline: Pathophysiology

MSC: Organ System: General

13. Xanthelasma may suggest that the patient has an abnormality of: a. lipid metabolism. NURSINGTB.COM 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 characteristics of a lipid metabolism problem. The other conditions are not associated with eye plaques. TOP: Discipline: Pathophysiology

MSC: Organ System: General

14. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

15. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

16. 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.

NURSINGTB.COM MSC: Organ System: Nervous

TOP: Discipline: Pathophysiology

17. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

18. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

19. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

20. 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. NURSINGTB.COM c. pupillary light reflex. d. nystagmus. e. corneal arcus 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

21. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

22. 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. TOP: Discipline: Physiology

MSC: Organ System: General

23. 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. TOP: Discipline: Pathophysiology N R

Organ U SINGMSC: TB.C OM System: Nervous

24. 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

25. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

26. 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

27. 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. N R I G B.C M

U S N T

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. On examination, papilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

28. 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 cotton wool patches and hemorrhages. Cataracts are clouding of the lens. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

29. Drusen bodies are most commonly a consequence of:

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d. e.

glaucoma. aging. presbyopia. papilledema. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

30. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

31. White specks scattered in a linear N Rpattern I Garound B.CtheMentire circumference of the iris are

called: a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy.

U S N T

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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

32. Opacities of the red reflex may indicate the presence of: a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. e. diabetes. ANS: C

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

33. What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic

agents when examining a pregnant patient 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

34. Episcleritis may indicate: a. lipid abnormalities. b. an autoimmune disorder. c. an anaphylactoid reaction. d. severe anemia. NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

35. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 36. 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 characteristics 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

37. 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.

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TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

38. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

39. Retinal hemorrhages in an infant require investigation for: a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor. d. child abuse. e. strabismus. ANS: D

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 13: Ears, Nose, and Throat Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: General

2. 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. N R I G B.COM e. produce a waxy lubricant. U S N T 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

3. 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. TOP: Discipline: Physiology

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

5. An infant s auditor canal, hen compared 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.

ith an adult s, is:

ANS: B

Compared ith an adult s, the infant s auditor canal is shorter and has an up ard cur e, which is why pulling the pinna down straightens the canal. TOP: Discipline: Gross Anatomy

MSC: Organ System: General

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6. When e amining an infant s middle ear, the practitioner should use one hand to stabili e 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. TOP: Discipline: Physiology

MSC: Organ System: General

7. The pregnant patient 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

8. 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. TOP: Discipline: Physiology

MSC: Organ System: General

9. 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

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About two-thirds of adults ages 70 years and older have a hearing loss that affects their daily living. 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. TOP: Discipline: Physiology

MSC: Organ System: Nervous

10. 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. TOP: Discipline: Pharmacology/Therapeutics

MSC: Organ System: Nervous

11. To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

200 to 400 Hz 500 to 1000 Hz 1500 to 2000 Hz Greater than 2000 Hz

ANS: C

Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. TOP: Discipline: Physiology

MSC: Organ System: Nervous

12. 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. TOP: Discipline: Physiology

MSC: Organ System: General

13. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorder. NURSINGTB.COM b. skeletal anomaly. c. renal disorder. d. Ménière disease. e. heart defect. ANS: C

A low-set position or unusual angle may indicate a genetic syndrome or be a clue to look for renal anomalies as the ears and kidneys grow at the same time during pregnancy. TOP: Discipline: Pathophysiology

MSC: Organ System: General

14. When conducting an adult otoscopic examination, you should: a. position the patient s head leaning to ard ou. 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 ill comfortabl fit in the patient s ear. The handle should be held bet een the thumb and the inde 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Physiology

MSC: Organ System: General

15. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

16. Placing the base of a ibrating tuning fork on the midline erte 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 erte of the patient s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. TOP: Discipline: Physiology

NURSINGTB.COM MSC: Organ System: Nervous

17. 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 tuning fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. The tuning fork is placed on the midline top of the patient s head for the Weber test, a test that helps assess unilateral hearing loss. TOP: Discipline: Physiology

MSC: Organ System: Nervous

18. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

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. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

19. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

20. 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

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A smooth red tongue with a slick appearance may indicate a 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

21. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

22. A hairy tongue with yellowish brown to black elongated papillae on the dorsum: a. is indicative of oral cancer.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

is sometimes seen after antibiotic therapy. usually indicates a vitamin deficiency. usually indicates anemia. is characteristic of a geographic tongue.

ANS: B

Recent antibiotic use can turn the tongue yellow-brown to black and hairy. TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal 23. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

24. Which variation may be an expected finding in the ear examination of a newborn? a. Diffuse light reflex b. Purulent material in the ear NUcanal RSINGTB.COM 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 ne born s t mpanic membrane does not become conical for se eral months; therefore, the light reflex appears diffuse. TOP: Discipline: Physiology

MSC: Organ System: General

25. 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. TOP: Discipline: Physiology

MSC: Organ System: General

26. Expected physical changes associated with older adults include:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d. e.

shiny buccal mucosa. teeth appear shorter. wetter nasal mucosa. bristly hairs in the vestibule. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

27. 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 e terna (s immer s ear) hen pulling the pinna reproduces ear pain. The other conditions do not commonly cause the same finding. TOP: Discipline: Pathophysiology

MSC: Organ System: General

28. Severe vertigo, tinnitus, and episodes of hearing loss are the characteristics of: a. cholesteatoma. NURSINGTB.COM b. Ménière disease. c. otosclerosis. d. cocaine abuse. e. labyrinthitis. ANS: B

Ménière disease is an inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, and ear fullness TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

29. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 14: Chest and Lungs Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Pulmonary/Respiratory

2. 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

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The apices of the lungs are 4 cm above the first rib. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

3. 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. e. relationship to the sternum. ANS: A

The number of each intercostal space corresponds to that of the rib immediately above it. TOP: Discipline: Gross Anatomy

MSC: Organ System: Pulmonary/Respiratory

4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Pulmonary/Respiratory

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

6. 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

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Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

7. 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 around 68.5 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

8. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

9. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

10. Bradypnea may accompany: a. pneumothorax. b. an excellent level of cardiovascular NURSINfitness. GTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

11. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

12. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

13. In which patient situation would you expect to assess tachypnea? a. Patient with depression b. Patient who abuses narcotics c. Patient with metabolic acidosis NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

14. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

15. Which site of chest wall retractions indicates a more severe obstruction in a patient with

asthma?

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d. e.

Lower chest Along the anterior axillary line Above the clavicles At the nipple line 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

16. 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. TOP: Discipline: Pathophysiology Organ NURSINGMSC: TB.C OM System: Pulmonary/Respiratory 17. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

18. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

19. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

20. 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

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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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

21. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

22. The examiner percusses for diaphragmatic excursion along the: a. vertebral column. b. midvertebral line. c. midaxillary line.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

23. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because

it: a. b. c. d. e.

amplifies all types of sounds. filters extraneous sounds. pinpoints focal sound areas. transmits high-pitched sounds. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

24. Breath sounds normally auscultated over most of the lung fields are called: a. vesicular. NURSINGTB.COM b. hyperresonance. c. bronchial. d. tubular. e. bronchovesicular. ANS: A

The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

25. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 26. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

27. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

28. To distinguish crackles from rhonchi, you should auscultate the lungs: a. before and after the patient NUcoughs. RSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

29. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

30. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

31. 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 between NUcharacteristic RSINGTB.C OM viral and bacterial sputum is the color. Whereas viral infections typically produce mucoid sputum, bacterial infections produce yellow, green, or rust-colored sputum. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

32. 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; id i ala mi g a a age. The e b i h id ce i m e m bile and prominent than in older children. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

33. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. normal, thin chest wall structures. d. pus-filled abscesses and tumors. e. tension pneumothorax. ANS: C

Y g child e che all a e all hi a d he ef e able harsh, and more bronchial breath sounds than can adults. TOP: Discipline: Physiology

mall

a mi l

MSC: Organ System: Pulmonary/Respiratory

34. 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. TOP: Discipline: Physiology

MSC: Organ System: Pulmonary/Respiratory

35. 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 painNand ribItenderness RS U NGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

36. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 15: Heart Ball: Seidel G ide

Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Cardiovascular

2. 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

NURSINGTB.COM

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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Cardiovascular

3. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

4. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

5. 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 through NURof GTB.C SIa Nstimulus OM 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). TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

6. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

7. The “pacing structure of the heart s electrical activity is the: a. atrioventricular (AV) node.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

bundle of His. Purkinje fibers. coronary sinus. sinoatrial (SA) node.

ANS: E

An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

8. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

9. 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.

NURSINGTB.COM

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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

10. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

11. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

12. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

13. In an adult, the apical impulse should beGmost visible NU RSIN TB.C OM 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

14. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

15. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

16. An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may

indicate: a. decreased cardiac output.NURSINGTB.COM b. dextrocardia. c. left ventricular hypertrophy. d. hyperventilation. e. obesity. ANS: C

MSC: Organ System: Cardiovascular

17. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

18. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

19. 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

NURSINGTB.COM

Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

20. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

21. The carotid pulse should coincide with which heart sound? a. S1 b. S2

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

22. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

23. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

24. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

25. A grade I or II murmur, without radiation and of medium pitch, is a common variation found

in: a. b. c. d. e.

school-age children. older women. middle-aged men. sedentary individuals. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

26. 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

NURSINGTB.COM

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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

27. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

28. Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

Mobitz type II Multifocal PVCs Sinus dysrhythmia Third-degree AV block

ANS: D

Sinus dysrhythmia 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

29. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

30. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

31. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

32. All of the following are characteristics of the Frailty syndrome in older adults except: a. weight gain. b. inability to climb one flight of stairs. c. inability to walk one block. d. most common in adults over age 70. e. linked to comorbid conditions. ANS: A

Frailty syndrome is characterized by signs and symptoms of being frail: weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. It is linked to comorbid conditions and carries an elevated risk of catastrophic declines in health and function, including disability, hospitalization falls, fracture, and death It is most common in adults older than 70 years old and is increasingly common after age 80 years of age. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 16: Blood Vessels Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

2. 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

NURSINGTB.COM

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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

3. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

4. Which of the following statements is true regarding the examination of peripheral arteries? a. The thumb should never be used to assess pulses.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

Palpate at least one pulse in each extremity, usually the most proximal one. The pulses are most readily felt over arteries that lie over bones. Extremity pulses do not normally generate waveforms. The pads of the fourth and fifth digits of the e a i e ha d a e he 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). TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

6. 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. e. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

7. Conduction system impairment should be suspected if an irregular heartbeat is: a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

8. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

9. A sound similar to a murmur that is heard over arteries is a: a. thrill. b. hum. c. friction rub. NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

10. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

11. T a. b. c. d. e.

a e a a ie j g la Supine Semi-Fowler Upright Left lateral recumbent Leaning forward

ei , he

he h

ld fi

be laced i

hich

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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

12. Observation of hand veins can facilitate the 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 ei hile he ha d i a he a ie ide. The ai e he ha d il he ei c lla e, a d then use a ruler to measure the vertical distance between the midaxillary line (level of the NURSI heart) and the level of the collapsed hand NGveins. TB.COM TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

13. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

14. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

15. 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. TOP: Discipline: Pathophysiology Organ NURSINGMSC: TB.C OM System: Cardiovascular 16. 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. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

17. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels. TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

18. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

19. 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 seen most commonly in the NURSINstenosis GTB.CorOnarrowing M 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Cardiovascular

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 17: Breasts and Axillae Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

2. 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 NURSINGTB.COM pregnant and lactating women. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

3. Around 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. Around 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

4. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 loosel as Cooper s ligaments relax. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

5. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

6. 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 e. Young age at birth of first child ANS: C

NURSINGTB.COM

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. TOP: Discipline: Biostatistics

MSC: Organ System: Reproductive

7. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

8. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. in the tail of Spence. ANS: C

The areola is the most common initial site to visuali e peau d orange skin. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

9. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

10. Recent unilateral inversion of a previously everted nipple suggests: a. obesity. b. cancer. c. benign breast disease. d. pregnancy. e. mastitis. ANS: B

URSINGofTaB.C OM everted nipple suggests malignancy Recent unilateral inversion orNretraction previously rather than a benign condition. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

11. 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. TOP: Discipline: Biostatistics

MSC: Organ System: Reproductive

12. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: B

The finger pads are used for breast palpation because they are more sensitive than the fingertips. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

13. 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. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

14. If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a

40-year-old patient s breast, ou 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 N R alcohol. I G B.C M ANS: D

U S N T

The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

15. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 16. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

17. When e amining a illar l mph 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

To e amine the a illa, support the patient s lower arm with the elbow fle ed with one of our hands and use your other hand to palpate the axilla. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

18. Lymphatic flow of the breastNprimarily RSINdrains: GTB.COM U 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

19. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

20. Male gynecomastia associated with recreational 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

21. 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 breastM infection will turn into a breast abscess. NUthe RSrisk INthat GTaB.C O 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

22. 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 movable 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, well-delineated 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 23. 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 mammar ridge (the milk line ). These nipples and areolae ma be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

24. All of the following are true statements about the risks of Breast Cancer Screening except: a. risk of false-positive results. b. possible pain from testing. c. possibility of adverse psychologic responses. d. there is little evidence that breast cancer screening reduces mortality. e. overdiagnosis of lesions that would not become clinically significant. ANS: D

While breast cancer screening is beneficial in reducing mortality, it also carries potential NUfalse-positive RSINGTB.C M harms. Potential harms include andO false-negative results, additional testing and biopsies, overdiagnosis (diagnosis of lesions that would not become clinically significant) and subsequent treatment, pain from testing, and adverse psychologic responses. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

25. Most of the benefit of mammography screening occurs in which age group? a. 24 to 50 b. 35 to 49 c. 50 to 74 d. 65 to 84 e. Over age 75 ANS: C

Breast cancer mortality is reduced with mammography screening, although estimates are of borderline statistical significance, the magnitudes of effect are small for younger ages, and results vary depending on how cases were accrued in trials. Most of the benefits of mammography results from screening during ages 50 to 74 years. There are insufficient data to assess the benefits and harms of screening women age 75 years or older. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 18: Abdomen Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

2. 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. NURSINGTB.COM TOP: Discipline: Gross Anatomy

MSC: Organ System: Gastrointestinal

3. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Gastrointestinal

4. One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

6. 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

N R I G B.C M

S N isTthe absorption O The major function of the largeUintestine of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

7. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

8. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

9. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

10. 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.N R I G B.C M U S N T O 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

11. 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

MSC: Organ System: Gastrointestinal

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

12. 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. TOP: Discipline: Biostatistics

MSC: Organ System: Gastrointestinal

13. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Gastrointestinal

NURSINGTB.COM

14. 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 slightl fle ed knees. The other choices increase muscle fle ion. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

15. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

16. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

17. 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 when may indicate an intestinal obstruction. N and R I G detected B.C M

U S N T

TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

18. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

19. Peritonitis often produces bowel sounds that are: a. decreased. b. increased. c. high pitched. d. absent. e. accentuated.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: A

Decreased bowel sounds occur with peritonitis and paralytic ileus. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

20. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

21. 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. TOP: Discipline: Physiology

NURSINGTB.COM MSC: Organ System: Gastrointestinal

22. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

23. 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. e. bladder fullness.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: D

Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

24. 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. TOP: Discipline: Embryology

MSC: Organ System: Gastrointestinal

25. 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. NURSINGTB.COM e. Wilms tumor. ANS: B

Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

26. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

27. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most

associated with:

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d. e.

peptic ulcer disease. pancreatitis. ruptured ovarian cyst. splenic rupture. diverticulitis.

ANS: E

No choice other than diverticulitis has all of these presenting symptoms. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

28. 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 s mptoms suggest peptic ulcer disease. The supporting laborator finding is the presence of H. pylori. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

29. Costovertebral angle tenderness should be assessed whenever you suspect the patient may

have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception.

NURSINGTB.COM

ANS: C

Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. TOP: Discipline: Pathophysiology

MSC: Organ System: Renal/Urinary

30. 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. TOP: Discipline: Embryology

MSC: Organ System: Gastrointestinal

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 31. 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 empt , and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Bab Joe s s mptoms? 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

32. 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.NURSINGTB.COM TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

33. Given the high certainty that screening results in reduced mortality, current recommendations

include screening for colorectal cancer beginning at age 50 and continuing until age: a. 65. b. 70. c. 75. d. 80. e. 85. ANS: C

In 2016 the U.S. Preventive Services Task Force (USPSTF) updated its previous recommendations based on a review of the evidence assessing both benefits and harms of screening. Given the high certainty that screening results in reduced mortality, the USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient s overall health and prior screening histor . TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 19: Female Genitalia Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

2. Wha

c e a e l ca ed a he 5 cl ck a d he 7 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

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Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

4. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: B

The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

6. 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). TOP: Discipline: Physiology

NURSINGTB.COM MSC: Organ System: Reproductive

7. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

8. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Physiology

MSC: Organ System: Reproductive

9. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

10. The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her

da gh e s underwear. Both the mother and daughter appear nervous and concerned. You ld eed a k e i a e he child : a. drug ingestion. b. fluid intake. c. risk for sexual abuse. d. hormone responsiveness. e. fat intake. ANS: C

Vaginal discharge in a child N could to a chemical irritation from soaps, lotions, or RSbeIrelated GTB.C M U N O powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

11. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

12. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

13. 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

Until further studies conclusively determine that gel lubricant does not adversely interfere with specimen analysis, we continue to recommend lubrication with water. However, if gel lubricant is used, a thin layer on the external surface of the blades only will help avoid contamination of the specimen. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

14. When performing a gynecologic examination, the examiner should change gloves after a. b. c. d. e.

chi g he a ie : anal area. Bartholin glands. Skene glands. cervix. urethra.

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ANS: A

Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

15. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

16. Which one of the following is a proper technique for use of a speculum during a vaginal

examination?

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d. e.

Allow the labia to spread; insert the speculum slightly open. Press the introitus upward; insert the closed speculum horizontally. Press the introitus downward; insert the closed speculum obliquely. Spread the labia; insert the closed speculum horizontally. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

17. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

18. An examiner rotated a brush N several the cervical os. The brush was withdrawn and R Itimes G into B.C M

U S N T

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. TOP: Discipline: Physiology 19. The i ali a i

f a la ge

MSC: Organ System: Reproductive

f cl e cell

suggests: a. trichomonal infection. b. bacterial vaginosis. c. candidiasis. d. gonorrhea. e. cervical cancer. ANS: B

NURSINGTB.COM

on your wet mount slide examination

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Microbiology

MSC: Organ System: Reproductive

20. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

21. 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 examinationNallows toB.C reach almost RSIyou GT M 2.5 cm higher into the pelvis to U N O 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

22. Prominent labia minora are a normal finding in: a. adolescents. b. menopausal women. c. newborns. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

23. The most common cause of a foul vaginal discharge in children is a(n): a. rectocele. b. foreign body. c. infection. d. ruptured hymen.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. accident. ANS: B

Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

24. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

25. Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy. a. 10 b. 16 c. 20 NURSINGTB.COM d. 24 e. 30 ANS: C

At 20 weeks of gestation, the fundal height reaches the level of the umbilicus. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

26. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

27. Asking the woman to close the introitus during a pelvic examination is a test for: a. endometriosis.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

rectocele. cervical polyps. muscle tone. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

28. 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). TOP: Discipline: Microbiology

MSC: Organ System: Reproductive

29. Mittelschmerz may occur in which phase of the menstrual cycle? a. Menstrual NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

30. Which of the following cancers is not associated with human papillomavirus (HPV) infection? a. Cervical b. Vaginal c. Vulvar d. Ovarian e. Penile ANS: C

HPV infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; anal and oropharyngeal cancer and genital warts in both men and women. Vaccination against HPV before exposure to the virus through sexual contact is recommended for preadolescent and adolescent girls and boys

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 20: Male Genitalia Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Reproductive

2. 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

NURSINGTB.COM

Darker pigmentation from other body skin is a normal finding on the penis and testicles. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

3. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

4. The greatest contribution to the volume of ejaculate comes from the: a. prostate.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

epididymis. seminal vesicles. corpus cavernosa. testes.

ANS: A

The major volume of ejaculatory fluid comes from the prostate gland. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

6. 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 N Rsperm I Gto develop. B.C M

U S N T

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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

7. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

8. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

inquire about previous penile infections. retract the foreskin firmly. transilluminate the glans. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

9. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

10. 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 NURSINGTB.COM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

11. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

12. A normal vas deferens should feel: a. tender. b. smooth. c. rugated. d. spongy. e. beaded. ANS: B

The vas deferens should normally feel smooth, discrete, and nontender. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

13. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

14. An enlarged, painless testicleNin R or adult INGTB.C UanSadolescent OM 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

15. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

16. 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. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

17. The most common type of hernia occurring in young males is: a. direct inguinal b. incisional. c. indirect inguinal. d. umbilical. e. femoral. ANS: C

NURSINGTB.COM

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

MSC: Organ System: Reproductive

18. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

19. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: D

Syphilitic chancre is a painless lesion with an indurated border and a clear base. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

20. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

21. 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.

N RSINGTB.COM

U TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

22. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

23. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

24. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

25. All males may receive the human papillomavirus vaccine through which age? a. 16 b. 26 c. 36 d. 46 e. 56 ANS: B

N R I G B.C M

U exposure S N Tto the virus O through sexual activity is recommended Vaccination against HPV before for preadolescent and adolescent girls and boys. All males may receive the vaccine through age 26 and should speak with their healthcare provider to determine whether getting vaccinated is right for them. The vaccine is also recommended for any man who has sex with men and men with compromised immune systems (including human immunodeficiency virus [HIV]) through age 26 if they did not get fully vaccinated when they were younger. TOP: Discipline: Physiology

MSC: Organ System: Reproductive

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 21: Anus, Rectum, and Prostate Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

2. 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 NU RSINGTB.COM palpable through digital rectal examination. TOP: Discipline: Gross Anatomy

MSC: Organ System: Renal/Urinary

3. 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 type 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. TOP: Discipline: Biostatistics

MSC: Organ System: Gastrointestinal

4. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The incidence rate of prostate cancer is more common in African Americans and in Caribbean patients of African ancestry; less common in Asian American and Hispanic/Latinos than in non-Hispanic whites. TOP: Discipline: Biostatistics

MSC: Organ System: Renal/Urinary

5. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

6. 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

NURSINGTB.COM

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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

7. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

8. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

9. 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. TOP: Discipline: Physiology

MSC: Organ System: Gastrointestinal

10. 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 N R I G B.C M

U S N T

ANS: A

A healthy prostate should not protrude more than 1 cm into the rectum. TOP: Discipline: Gross Anatomy

MSC: Organ System: Renal/Urinary

11. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Renal/Urinary

12. Very light tan or gray stool may indicate: a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: B

Very light tan or gray stools suggest obstructive jaundice. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

13. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

14. 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, NURSINGTB.COM unnecessary biopsies, and overdiagnosis. TOP: Discipline: Biostatistics

MSC: Organ System: Renal/Urinary

15. A lower spinal cord lesion may be indicated by which finding? a. Lack of an anal ink 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 ink. A nega i e ink ma indica e a lo e inal co d le ion. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

16. Pinworms and Candida may both cause: a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation. ANS: C

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Pinworms and Candida both cause perirectal irritation and itch. TOP: Discipline: Microbiology

MSC: Organ System: Gastrointestinal

17. 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 healthcare 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Gastrointestinal

18. 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. N R I G B.C M

U S N T

TOP: Discipline: Pharmacology/Therapeutics MSC: Organ System: Gastrointestinal 19. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Reproductive

20. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric. TOP: Discipline: Pathophysiology

MSC: Organ System: Renal/Urinary

21. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Renal/Urinary

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 22: Musculoskeletal System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

2. 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

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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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

3. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

4. Ligaments are stronger than bone until: a. birth.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

infancy. adolescence. middle adulthood. old age.

ANS: C

Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

5. The elasticity of pelvic ligaments and softening of cartilage in a pregnant patients are caused

by: a. b. c. d. e.

decreased mineral deposition. increased hormone secretion. uterine enlargement. gait changes. increased mineral resorption.

ANS: B

MSC: Organ System: Musculoskeletal

6. Skeletal changes in older adults are the result of: a. increased bone deposition. b. increased bone resorption. NURSINGTB.COM 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

7. 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. TOP: Discipline: Gross Anatomy

MSC: Organ System: Musculoskeletal

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 8. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

9. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

10. Pain, disease of the muscle, and damage motor NUR INGtoTthe B.C M neuron may all cause: S O 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

11. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

12. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

13. 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. TOP: Discipline: Pathophysiology N R

Organ U SINGMSC: TB.C OM System: Musculoskeletal

14. 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

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

MSC: Organ System: Musculoskeletal

15. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

16. Ulnar deviation and boutonniere deformities are characteristics 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

17. 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 the distal M end of the fingers and are associated with NURSINofGT B.C O 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

18. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

19. Classic carpal tunnel syndrome would result in: a. pain in the fourth and fifth digits. b. a negative Phalen test.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

20. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

21. Arm length is measured from the acromion process through the: a. olecranon joint to carpal thumb hinge. b. olecranon process to distal NUulnar RSIprominence. NGTB.COM 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). TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

22. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

23. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

24. 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 backward. Anterior or posterior movement of NURpush GTtibia B.C SINthe OM the knee greater than 5 mm in either direction is an unexpected finding. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

25. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

26. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

valgus stress Apley Lachman 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

27. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

28. What technique is performed at every infant examination during the first year of life to detect

hip dislocation? a. Ballottement maneuvers N R I G B.C M U S N T O b. Barlow-Ortolani maneuvers c. Range of motion d. Thomas McMurray assessment e. Trendelenburg test ANS: B

A e e e ami a i d i g a i fa fi ea f life, he Ba l -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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

29. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

30. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

31. 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.

NURSINGTB.COM MSC: Organ System: Musculoskeletal

TOP: Discipline: Pathophysiology

32. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

33. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

34. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

35. Dupuytren contracture affects the: a. hip flexor muscle. b. plantar fascia. c. carpal tunnel. d. palmar fascia. NURSINGTB.COM e. rotator cuff. ANS: D

A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

36. 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 d age h m . TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 23: Neurologic System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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. 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

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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. 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 counterbalancing manner to conserve body resources and maintain day-to-day body functions such as digestion and elimination. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. 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 ce eb m 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

5. 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

NURSIN GTB.C The thalamus is the major integrating center for perception of various sensations such as pain OM 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

6. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 7. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

8. 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.NURSINGTB.COM TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

9. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

10. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: B

MSC: Organ System: Nervous

11. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

12. The finger-to-nose test allows assessment of: a. coordination and fine motor function. NURSINGTB.COM b. point location. c. sensory function. d. two-point discrimination. e. 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 of the other choices test sensory function without motor function. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

13. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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). TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

14. As Mr. B enters the room, you observe that his gait is wide based and he staggers from side to

ide hile a ing hi dystonic ataxia. cerebellar ataxia. steppage gait. tabetic stamping. Parkinsonian gait.

nk. Yo

o ld doc men M . B pa e n a :

a. b. c. d. e.

ANS: B

A ce ebella gai (ce ebella a a ia) occ hen he pa ien fee a e ide 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, he pa ien po e i ooped, and he bod i held igid; ep a e ho and h ffling, i h hesitation on starting and difficulty stopping. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

GTB.Cwho URSI OMare experiencing: 15. Deep pressure tests are used N mostly forNpatients 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

16. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. G aphe he ia e he pa ien abili o iden if he fig e being d a n 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

17. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

18. 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.

NURSINGTB.COM 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. a e e onl he do al face of he foo i h he pa ien e e open.

ANS: C

The monofilamen i placed on e e al moo h po of he pa ien plan a foo fo seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

19. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Te he ankle clon hen efle e a e h pe ac i e. S ppo he pa ien knee in a fle ed 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

20. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

21. Cranial nerve XII may be assessed in an infant by: a. a ching he infan facial e p e ion hen c ing. b. observing the infant suck and swallow. c. clapping hands and watching the infant blink. d. ob e ing he infan oo ing efle . e. checking he infan gagNefle URS. INGTB.COM 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 i e in a midline po i ion. Wa ching he infan facial e p e ion hen c ing a e e 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

22. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 23. Emotional lability, personality changes, and contralateral hemiplegia greater in the lower than

upper extremities 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 cerebral artery. ANS: E

The anterior cerebral artery supplies superior surfaces of frontal and parietal lobes and medial surface of cerebral hemispheres (includes motor and somesthetic cortex serving the legs), basal ganglia, corpus callosum. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

24. A postinfectious disorder following a nonspecific gastrointestinal or respiratory infection that

causes an acute neuromuscular paralysis is: a. cerebral palsy. b. HIV encephalopathy. c. Guillain-Barré syndrome. d. Rett syndrome. e. myasthenia gravis. ANS: C

Guillain-Barré syndrome is an autoimmune disorder triggered by a bacterial or viral infection that damages the peripheral nerves, leading to denervation and atrophy. TOP: Discipline: NeuroscienceNURSINGMSC: Organ TB.C OM System: Nervous 25. 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 an autoimmune disorder of neuromuscular junction involved with muscle activation; autoantibodies directed against the acetylcholine receptors in the neuromuscular junction cause destruction and inflammatory changes in the postsynaptic membranes that lead to muscle dysfunction. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

26. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: D

Pseudotumor cerebri is a clinical syndrome of intracranial hypertension that mimics brain tumors. Etiology is unknown, but proposed causes are excess cerebrospinal fluid (CSF) production or malabsorption. Obstructed venous drainage of CSF is also a potential cause. Obesity is considered a contributing factor. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 24: Sports Participation Evaluation Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

2. 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. N R I G B.COM e. performing jumping-jacks.U S N T ANS: B

Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

3. Your 15-year-old female 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. The risk of stress fracture increases. The problem needs early recognition as it may be irreversible if discovered too late. The thorough menstrual history is a critical component of the PPE in female athletes. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

5. Which medical condition would exclude one from sports participation? a. Asthma b. Fever c. Controlled seizures d. Stage 1 hypertension e. Sickle cell trait ANS: B

Two conditions considered absolute contraindications to sports participation are carditis and fever. Carditis (inflammation of the heart) can result in sudden death with exertion, and fever is associated with an increased risk of heat-related illness. Fever can increase cardiopulmonary effort and impair exercise capacity. Asthma, seizures, stage 1 hypertension, and sickle cell trait, when controlled, do not exclude exercise.

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TOP: Discipline: Pathophysiology

MSC: Organ System: General

6. 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. TOP: Discipline: Pathophysiology

MSC: Organ System: Musculoskeletal

7. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 25: Putting it All Together Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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

Ackno ledging the patient s discomfort during the e amination ill 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

2. The reliability of health-related findings and observations is the responsibility of the: a. patient. b. healthcare professionals. c. attending clinician. d. patient and patient s famil . NURSINGTB.COM 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

3. 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% sensiti it and specificit . ANS: D

No test has 100% sensitivity and specificity. TOP: Discipline: Biostatistics

MSC: Organ System: General

4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. improve patient flow. d. minimize the time the patient is in the room. e. maximize patient movements to assess their mobility. ANS: A

MSC: Organ System: General

5. 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 e amining table. In the sitting position, ou can e amine the patient s anterior and posterior upper trunk and head, which comprise the majority of focused assessments. TOP: Discipline: Behavioral Science

MSC: Organ System: General

6. An ophthalmoscopic eye examination involves: a. lens inspection. NURSINGTB.COM b. near vision evaluation. c. sclera observation. d. visual field assessment. e. assessing extraocular eye muscles. ANS: A

MSC: Organ System: Nervous

7. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Physiology

MSC: Organ System: Cardiovascular

8. 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. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

9. 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.

NURSINGTB.COM MSC: Organ System: Nervous

TOP: Discipline: Neuroscience

10. 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

11. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends o er at the aist and test the patient s range of motion. TOP: Discipline: Physiology

MSC: Organ System: Musculoskeletal

12. 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. TOP: Discipline: Biostatistics

MSC: Organ System: General

13. 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 examinationNsequence depends RSING B.Con Mtheir cooperation for as long as possible. U T O To promote this, examine the child while the parent is holding the child, while maximizing both inspection and opportunities for physical examination. TOP: Discipline: Behavioral Science

MSC: Organ System: General

14. 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

MSC: Organ System: General

15. In crying infants, it is often difficult to: a. perform tactile fremitus assessments. b. determine lung expansion. c. auscultate heart sounds.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. TOP: Discipline: Physiology

MSC: Organ System: General

16. When you attempt to move a 10-month-old child from his mother s lap to the e amination

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 e amination hile 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 e amination 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. TOP: Discipline: Behavioral Science

MSC: Organ System: General

17. Observation of the child playing information about which two N Rin the I playroom G B.Cprovides M

U S N T

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 s stems b noting the child s coordination of acti ities, such as hen thro ing a ball, drawing, coloring, walking, and jumping. TOP: Discipline: Physiology

MSC: Organ System: General

18. When conducting a geriatric assessment, basic activities of daily living (ADL) include: a. bathing. b. housekeeping. c. medication compliance. d. communication skills. e. money management. ANS: A

Basic ADL include bathing, dressing, toileting, ambulating, and feeding. All of the other choices represent instrumental ADL.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

TOP: Discipline: Behavioral Science

MSC: Organ System: General

19. 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 pro ide a great deal of information about the indi idual s independent functional capacity. Attention should be given to self-care activities and instrumental activities. TOP: Discipline: Behavioral Science

MSC: Organ System: General

20. Which of the follo ing is not assessed in a ne born 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, pro ides insight to the bab s in utero, intrapartum, and immediate postnatal NURSIexperience. GTB.COAMlow score for several of the N variables color, heart rate, respirations, muscle tone, and reflex irritability is evidence of difficulty. TOP: Discipline: Behavioral Science

MSC: Organ System: General

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 26: Emergency or Life-Threatening Situations Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i 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

Thi a e ic c i g f he a ie e ba , , a d e e e i g responses to ecific i i a e he ce eb a c e a d b ai e f c i . The a ie be response in each category is matched to the criteria for scoring. The lowest score in each category is 1. TOP: Discipline: Pathophysiology

MSC: Organ System: General

2. Status epilepticus is defined as: a. seizures with intermittent recovery of consciousness. b. nonconvulsive brain wave disturbance with psychomotor dysfunction. c. protracted convulsions with unresponsiveness lasting up to an hour. d. seizures that result in hypotension, pallor, and prolonged diaphoresis. e. convulsive activity uncontrolled by medication. ANS: C

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Status epilepticus is characterized by seizures that are protracted and recurrent without recovery of consciousness. TOP: Discipline: Pathophysiology

MSC: Organ System: Nervous

3. 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. TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

4. Paradoxical chest movement suggest a: a. spontaneous pneumothorax. b. status asthmaticus. c. clavicle fracture.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. pulmonary contusion. e. flail chest. ANS: E

Paradoxical chest movement is associated with fractured ribs or a flail chest. This fracture should be stabilized immediately. TOP: Discipline: Pathophysiology

MSC: Organ System: Pulmonary/Respiratory

5. 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 ig ifica di abi i . A e he a ie e e f c ci e i h he G a g C Scale. TOP: Discipline: Pathophysiology

MSC: Organ System: General

6. 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 photophobia. NUReye Iwith GT B.COM S N 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

7. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank TOP: Discipline: Pathophysiology

MSC: Organ System: General

8. 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 dysrhythmias 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. TOP: Discipline: Pathophysiology

MSC: Organ System: General

9. 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.

NURSINGTB.COM MSC: Organ System: General

TOP: Discipline: Pathophysiology

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 01: The History and Interviewing Process Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. Which e i d be c ide ed a eadi g e i ? a. Wha d hi i ca i g headache ? b. Y d ge headache f e , d ? c. O a ca e f 1 10, h d a e he e e i f headache ? d. A ha i e f he da a e headache he e e e? ANS: B

Stating to the patient that he or she does not get headaches would limit the information in the a ie a e . A i g he a ie ha he he hi i ca i g he headache i a open-ended 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When are open-ended questions generally most useful? a. During sensitive area 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

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Asking open-ended questions during the sensitive part of the interview allows you to gather more information and establishes you as an empathic listener, which is the first step of effective communication. Asking closed-ended questions may stifle the patie de i e discuss the history of the illness. 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. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr.

i a , I e had hi c gh f 3 da , a d i ge i g e. Y e , Te e e ab c gh. M . F a i a e , I i h I c d e e. Tha h I he e. Y e e ha g! Which ca egi e e e d be a ia e f enhancing communication? a. Af e 3 da , e i ed f c ghi g. Ha e had a fe e ? b. I d i e hea e ab e e ie ce . Whe e e e b ? c. I d ha g. Y c d ha e a a di ea e. d. I e a i e a d fig e a e ha he be i . ANS: A

Af e 3 da , e i ed f c ghi g. Ha e had a fe e ? i he e e ai ed a focusing on the chief compliant to gather more data and does not digress from the issue. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Af e

a a a ie ab he fa i hi , he a , Te e ab Which response is generally most appropriate? a. Ig e he a ie 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

fa i

N R I G B.C M

U will S Nsatisfy T the Oa ie c i i ab Giving a brief, undetailed answer ef ih i adi g i a e ife. Ig i g he a ie c e , c i i g i h he i e ie , a d 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. If you as a healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. M . A a e , M

ife i j ai f . I i h i . She a ea de e ed. Which of the following statements is the most appropriate caregiver response? a. T hi ab he g d hi g i ife. b. Wha i ife i ca i g ch ai ? c. Y ca ea ha e a i g. d. If hi ab i, hi g i h ge i g hi e ab .

ANS: B

Specific but open-ended questions are best used when the patient has feelings of loss of selfh a d de e i . T hi ab he g d hi g i ife, Y ca ea e a i g, a d If hi ab i, hi g i h ge i g hi e ab ae statements that will hurry the patient and offer only superficial assurance.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the

examination room. When collecting history from older children or adolescents, they should NURSINGTB.COM 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 adolescent should be given the opportunity to give information directly. This enhances the probability that the adolescent will follow your advice. Mailing a questionnaire in advance to avoid the need for her to talk does not assist the adolescent 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 healthcare provider should a a di ec he f f he i e ie acc di g he a ie e e. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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. healthcare practices.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d.

e e be i g (

edge) ab

eg a c .

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, healthcare practices, and he a e e be i g ( edge) ab he eg a cy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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 healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. To what extent should the patient or emotional disorder be involved N Rwith I aGphysical B.C disability M

U S Nto Tthe health O professional? in providing health history information 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. When taking a history, the nurse should: a. ask the patient to give you any information he or she can recall about his or her

health. b. a he i e ie i h he a ie fa i hi c. use a chronologic and sequential framework. d. use a holistic and eclectic structure.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 any information they can recall about their health and using a holistic and electric structure do not provide structure to he hi . Ga he i g he a ie fa i hi i he fi e . DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. When questioning the patient regarding his or her sexual history, which question should be

asked initially? a. D ha e a a ic a e a i e di i e ? b. D ha e a ie c ce ega di g e c. H fe d ha e i e c ea d ih h ? d. D ha e a ea hi a ha e bee e tra i ed i fec i ?

ife? ed

a e a

ANS: B

When approaching questioning about a sensitive area, it is recommended that the provider first ask open-e ded e i ha e e he a ie fee i g ab he i e. Do you ha e a a ic a e a i e di i e ? i a e i ha h d be a ed i a i e ie ega di g e a hi . H fe d ha e i e c ea d ih h ? a d D ha e a ea hi a ha e bee e ed a exually transmitted i fec i ? a e e i ha h d be a ed initially in an interview regarding the a ie e a hi . DIF: Cognitive Level: Applying (Application) NURSINGMSC: OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation TB.C OM 14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Direct questioning about domestic violence in the home should be: a. a routine component of history taking with female patients. b. a ided f fea f ffe di g he a a e. 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 be a ided f fea f ffe di g he a a e , h d be a f a i e examination, and should not be used only when the patient is obviously being victimized. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. A tool used to screen adolescents alcoholism is the: NURfor SINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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 a d e i e T hea h? 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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 (ADL) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. ANS: B

Af ci a a e e i a a e e f a a ie bi i , e e e i y movement, household management, ADL, and instrumental activities of daily living (IADL). DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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 pain, fever, chills, malaise, fatigue, night sweats, sleep patterns, and weight (average, preferred, present, change).

N R I G B.C M

U S (Comprehension) N T O DIF: Cognitive Level: Understanding OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 1. Which are appropriate for the interview setting with a patient? (Select all that apply.) a. Playing music in the background b. Ensuring comfort for all involved c. Maintaining eye contact d. Using a conversational tone e. Keeping the door open f. Removing physical barriers ANS: B, C, D, F

The interview setting requires comfort for all involved, removal of physical barriers, unobtrusive access to a clock, maintaining eye contact, and using a conversational tone. Playing music in the background may be distracting and keeping the door open does not provide for privacy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 02: Cultural Competency Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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.

NURSINGTB.COM

ANS: C

A fixed image of any group that rejects its potential for originality or individuality is the defi i i f ee e. Acc l a i i he ce f ad i g a he c l e beha i . A norm is a standard of allowable behavior within a group. Ethnos implies the same race or nationality. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Mr. L presents to the clinic with severe groin pain and a history of kidney stones. M . L

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. Wi h fa he e i i , e ill e a i e he e a d equest that it be e ed hi . b. The e be e he lab f e a i a i a d he ef e ca be ke . c. We ca le hi kee hi e beca e i i la e i fec i c l lic . d. We d k e if fa he ha a he kid e e, e a al e hi e.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: A

We should be willing to modify the delivery of health care in a manner that is respectful and i kee i g i h he a ie c l al backg d. Wi h fa he e i i , e ill e a i e he e a d e e ha i be e ed hi i he appropriate response. The e be e he lab f e a i a i a d he ef e ca be ke a d We d k e if fa he ha a he kid e e, e a al e hi e d he a ie e e . We ca le hi kee his stone because it violates our i fec i c l lic d e ide a ea ha i ld i la e a i fec i c l policy. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The

c l a. b. c. d.

i ai f he heal hca e fe i al all c ee , ha e , i called: cultural knowledge. cultural awareness cultural desire cultural skill.

e gage i

f bec

i g

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 e bia e , e e e , ej dice , a i , a d -i ha e h ld ab individuals and groups who are them. NUdifferent RSINGfrom TB.C OMCultural knowledge is the process of seeking and obtaining a sound educational base about culturally and ethnically diverse groups. C l al kill i he abili c llec c l all ele a da a ega di g he a ie ee i g problem, as well as accurately performing a culturally based physical assessment in a culturally sensitive manner. Cultural desire is the motivation of the healthcare professional to want to engage in the process of becoming culturally competent, not have to. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic.

Which e i ha he e ial f e l i g a a ie health problem? a. H fe d ha e edical e a i a i ? b. Wha i age, ace, a d ed ca i al le el? c. Wha e f ha e bee ha i g? d. Wh d hi k a e ha i g he e ?

c l

al belief ela ed

ANS: D

Wh d hi k a e ha i g he e ? i a e -ended question that avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be e cha ged. The he e i d e l e he a ie c l al belief ab heal h problems.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The definition of ill or sick is based on a: a. stereotype. b. cultural behavior. c. belief system. d. cultural attitude. ANS: C

The defi i i f ill ick i ba ed large part by his or her enculturation.

he i di id al belief

a d i de e

i ed i

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids

e e c ac a d a e e i l b a i g, Yeah, N , the following is appropriate for the interviewer to say or ask? a. We ill be able c ica e be e if l k a e. b. I ha d f e ga he ef l i f a i beca e a c. A e c f able alki g i h e? d. D e eligi ake i ha d f a e e i

Ig e

. Which of

e ae

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.

N R I G B.C M

S N T O DIF: Cognitive Level: ApplyingU(Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. A

e lai a ie c di i he h ba d, ice ha he i lea i g ad 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. An aspect of traditional Western medicine that may be troublesome to many Hispanics,

Na i e A e ica , A ia , a d Middle Ea e g i We e edici e a e 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d.

e bala ce i a i di id al life.

ANS: B

A more scientific approach to healthcare 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 ha be ee a e a d he e i e c , a d e i g bala ce i a i di id al life would not be troublesome to many Hispanics, Native Americans, Asians, and Arabs. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The attitudes of the healthcare 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 healthcare provider are foundationally derived from his or her own culture; understanding this is relevant to the success of patient relationships. Attitudes of the healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

N R I G B.C M

U S N who T has O 11. Mr. Sanchez is a 45-year-old gentleman presented to the office for a physical examination to establish a new primary care healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Mr. Jones is a 45-year- ld a ie

he ffice. A e

defi ition of illness is

likely to be most influenced by: a. race. b. socioeconomic class. c. enculturation. d. age group. ANS: C

The defi i i f ill e i de e i ed i la ge a b he i di id al e c l a i ( he process whereby an individual assumes the traits and behaviors of a given culture). DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. As the healthcare 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 NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. An example of a cold condition is:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

a fever. a rash. tuberculosis. an ulcer.

ANS: C

A cold condition in cultures with a holistic approach is tuberculosis. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

M M del i cl de P ce NfUCRS l Ial e eOce NGCTB.C constructs? (Select all that apply.) a. Desire b. Awareness c. Thought processes d. Skill e. Language

2. Campinha-Bac e

hich c l

ANS: A, B, D

Campinha-Bac e P ce f C l al C e e ce M del i cl de he c l encounters, desires, awareness, knowledge, and skill.

al c

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 03: Examination Techniques and Equipment Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. 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

Handwashing 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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 NUtoRcontrast B.COM SINGTdye d. The patient who is allergic 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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 our touch and what ou are feeling; it is not possible to perform palpation and listen to the patient talking at the same time.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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 validationNbefore or delegation. Before you call the clinician, you RSIreferral GTB.C M U N O 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. You are planning to palpate the abdomen of our patient. Which part of the e aminer 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The dorsal surface of the hand is most often used for the assessment of: a. crepitus. b. temperature.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation N R I GMSC: B.C M

U S N T

9. 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 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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 ofNtheRnondominant hand on the body surface, with the U SINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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)

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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 onlyNequipment R I Gneeded B.Cis the M stethoscope.

U S N T

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 17. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. A scale used to assess patients weight should be calibrated: a. only by the manufacturer. b. by a qualified technician N at regularly scheduled intervals. URSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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)

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

21. The infant should be placed in which position to have his or her height or length measured? a. Verticall , with the e aminer s hands under the infant s a illae 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. You are using an ophthalmoscope to e amine a patient s inner e e. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

N R I G B.C M

N Tis usedO to evaluate: 23. The pneumatic attachment for U the S otoscope 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Mr. Walters, a 32-year-old patient, tells ou 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Transillumination functions on the principle that: a. air, fluid, and tissue transmit light differentially. b. black light causes certain substances to fluoresce.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following are the causes of hyperreflexia? (Select all that apply.) a. Cold stirrups b. Standard scale c. Insertion of a speculum d. Fever e. Pressure during bimanual examination 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 04: Clinical Reasoning Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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 and a presumed diagnosis is made, the next step is to consider the appropriate laboratory tests, imaging studies, or specialty consultations. DIF: Cognitive Level: Understanding (Comprehension) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

evaluating

2. 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 yourNattention the central GTB.C URSINfrom OM issues. DIF: Cognitive Level: Understanding (Comprehension) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

3. Which 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) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

4. The adage ha c mm blem cc c mm l ad i e he ac i i e : a. al a diag e he a ie s problem in terms of what their practice usually sees. b. refer any uncommon complaints to specialists as soon as possible. c. not consider more than one diagnosis unless necessary. d. examine uncommon problems critically before assuming that the issue is an

unusual presentation of a common problem.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: C

This adage is to guide the practitioner to pay attention to unexpected or unusual findings but not to consider more than one diagnosis unless necessary and to favor the simplest hypothesis when competing hypotheses exist. DIF: Cognitive Level: Analyzing (Analysis) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

5. 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 e ima e f he babili f cce f ll achie i g he a ie g al a d he ili implementation. DIF: Cognitive Level: Remembering (Knowledge) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

6. Utilitarianism can be described as: a. balancing interests. b. preventing harm. c. choosing wisely. d. doing good. ANS: C

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Utilitarianism occurs when one considers appropriate use of resources with concern for the g ea e g d f he la ge c mm i . I al mea ch e i el . DIF: Cognitive Level: Remembering (Knowledge) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

7. 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) MSC: Safe and Effective Care: Management of Care 8. Self-analysis assists providers in giving proper context to: a. history and physical findings. b. therapeutic options.

NURSINGTB.COM

OBJ: Nursing process

diagnosis

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

9. Medical decision making requires a balance between: a. trust and suspicion. b. ethical and unethical behavior. c. remembering and superstition. d. mechanism and probabilism. ANS: D

In making medical decisions, you cannot be too scientific or pursue every possible scenario. DIF: Cognitive Level: Understanding (Comprehension) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

10. A valid history and physical examination can serve to: a. create higher healthcare costs. b. limit the indiscriminate use of diagnostics. c. threaten patient satisfaction. d. increase the risk of liability. N R I G B.C M ANS: B

U S N T

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) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

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. 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) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

12. Mr. Johnson actually has streptococcal pharyngitis; however, the throat culture is initially read

as negative. This situation describes a test with a:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

low sensitivity. high sensitivity. high specificity. 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) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

13. Which of the following is not a component of a management plan? a. Presumptive diagnosis b. Patient education c. Diet modification d. Physical therapy ANS: A

The management plan details what you are going to do about a patient problem such as education, diet modifications, and physical therapy referrals. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process implementing MSC: Safe and Effective Care: Management of Care 14. When determining actions for the management plan, the practitioner should first address: a. problems in the order of their chronologic development. b. he a ie s concern about problem.M N aRparticular SIciNGc TmB.C O. c. he a ie cial a d ec U mic a ce 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 patie . The f c add e i g he a ie cial a d economic circumstances. DIF: Cognitive Level: Understanding (Comprehension) MSC: Safe and Effective Care: Management of Care

OBJ: Nursing process

diagnosis

MULTIPLE RESPONSE 1. When utilizing a joint approach with the patient, which factors are likely to be considered?

(Select all that apply.) a. Consultations b. Laboratory studies c. Assistive technology d. Patient education e. Practitioner background ANS: A, B, C

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank A joint approach between the patient and practitioner should include laboratory and imaging studies, subspecialty consultation, medications, equipment, special care, diet and activity modification, follow-up visit, and patient education. DIF: Cognitive Level: Remembering (Knowledge) MSC: Safe and Effective Care: Management of Care

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OBJ: Nursing process

evaluating

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 05: Documentation Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. Which pa of he info ma ion con ained in he pa ien a. Subjective information only b. Objective information only c. Diagnostic information only d. All information

eco d ma be

ed in co

ANS: D

An hing ha i en e ed in o a pa ien document and can be used in court.

eco d, in pape o elec onic fo m, is a legal

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 2. 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 M . S lo of appe i e, i o ld be be e o: 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

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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 3. Which 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. 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 5. 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

N R I G B.COM

U useful S Nto:T 6. Drawing of stick figures is most 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 7. Which i an e ample of a p oblem ha e a. Common age variations b. Expected findings c. Problems needing further evaluation d. Minor variations

i e eco ding on he pa ien

ANS: C

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p oblem li ?

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 8. 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 9. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. d. plan. ANS: C

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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 10. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 11. 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. 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 12. 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 ign and mp om and hi o ical da a of he pa ien complaint are placed in the history of present illness.

e pe ience ha led p o he chief

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process communication documentation NURSINGand TB.COM MSC: Physiologic Integrity: Basic Care and Comfort 13. The effec of he chief complain on he pa ien

life

le i eco ded in hich ec ion of he

medical record? a. Chief complaint b. History of present illness c. Past medical history d. Social history ANS: B

The effec of he pa ien complain on c recorded in the history of present illness.

en e e da life

le o

o k pe fo mance i

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 14. The pa ien pe cei ed di abili ie and f nc ional limi a ion a e eco ded in he: a. problem list. b. general patient information. c. social history. d. history of present illness. ANS: D

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The hi o of p e en illne con ain info ma ion abo he pa ien life disabilities or functional limitations that alter activities of daily living.

le, as well as

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 15. 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 16. 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

N R I G B.C M

U contains S N T O such as allergies to drugs and foods and The past medical history section information environmental allergies. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 17. Information recorded about an infant differs from that recorded about an adult, mainly

beca e of he infan : a. attention span. b. developmental status. c. nutritional differences. d. source of information. ANS: B

The o gani a ional c e of an infan eco d i diffe en beca e he infan future health is referenced in terms of developmental status.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 18. Which finding is unique to the documentation of a physical examination of an infant? a. Fontanel size

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en and

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 19. Data relevant to the social history of older adults includes information on: a. family support systems. b. previous healthcare 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 20. A SOAP note is used in which type of recording system? a. Preventive care b. Problem oriented NURSINGTB.COM 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 21. The e amine e al a ion of a pa ien a. history of present illness. b. review of systems. c. physical examination. d. patient education.

men al a

belong in he:

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 22. Which format 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 pa ien complain ; a ha poin , SOAP doc men a ion i topped. DIF: Cognitive Level: Applying (Application) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort 23. George Michaels, a 22-year-old pa ien , ell

he n e ha he i he e oda o check hi alle gie . He ha been ha ing g een na al di cha ge fo he la 72 ho . Ho o ld he nurse document his reason for seeking care? a. GM is a 22-year-old male he e fo alle gie . 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 he e fo ha ing g een na al di cha ge for the past 72 hours. ANS: D

Doc men a ion of he chief complain al O a M be done b NURSINho GTld B.C words in quotation marks. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Integrated process communication and documentation MSC: Physiologic Integrity: Basic Care and Comfort

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ing he pa ien

o n

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 06: Vital Signs and Pain Assessment Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. During expiration, 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 increaseNthe space. URintrathoracic SINGTB.C OM 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) 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) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The most frequent cause of serious hypertension in children is: a. heart disease. b. liver failure. c. renal disease. NURSINGTB.COM d. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. Unde e ima ion of blood p e e ill occ 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.

if he c ff

id h co e :

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)

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

8. Which pulse characteristic in the neonate may indicate infection? a. Bounding pulse rate b. Regular pulse rate c. Sustained high pulse rate d. Intermittent slow pulse rate ANS: C

Sustained tachycardia in a neonate may be the first indication of infection. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Infants delivered by Cesarean section demonstrate which respiratory characteristic in

comparison to infants delivered vaginally? a. Slower respiratory rate b. Faster respiratory rate c. Shallower respirations d. Deeper respirations ANS: B

Infants delivered by Cesarean section may have a more rapid respiratory rate than babies delivered vaginally. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE

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1. Which 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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 07: Mental Status Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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 abilit to interact within the environment is a priority of the mental status evaluation. DIF: Cognitive Level: Remembering (Knowledge) 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

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The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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 youNtheRmeaning of a proverb, metaphor, or fable assesses the U S.IAsking NGTB.C OM to tell ou the meaning of a proverb or patient s abilit to reason abstractl the patient metaphor does not assess level of consciousness, emotional stability, or memory. The Mini-Mental State Examination tests memory. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Peripheral neuropathy is most likely to be manifested by: a. impaired memory. b. impaired abstract reasoning. c. impaired writing ability. d. hallucinations.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: C

Uncoordinated writing or drawing may indicate peripheral neuropathy, dementia, parietal lobe damage, or a cerebellar lesion. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Loss of immediate and recent memory with retention of remote memory suggests: a. attention-deficit/hyperactivity disorder (ADHD). b. impaired judgment. c. stupor. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Which observation would be most significant when assessing the condition of a patient who

has judgment impairment?

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

Repeated failure to fulfill family obligations Forgetting famil members birth dates Going to church three times a week Planning for retirement in 20 years

ANS: A

Inadequately dealing with family and social affairs indicates impaired judgment, whereas the other choices do not. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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 e amined 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Which type of hallucination is commonly associated with alcohol withdrawal? NUmost RSI NGTB.COM a. Olfactory b. Visual c. Auditory d. Tactile ANS: D

Tactile hallucinations are most commonly associated with alcohol withdrawal. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. A clinical syndrome of failing memory and impairment of other intellectual functions, usually

related to obvious structural diseases the B.C brain, describes: NURSIofNG T OM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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)

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

20. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. 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 NUand RSsocial INGTwithdrawal, B.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. While interviewing a patient, ou ask him to e plain 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which clinical assessments test attention span? a. Spell WORLD backward. b. Draw a clock. c. Say the days of the week. d. Do arithmetic calculations. e. E plain 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which are signs and symptoms of dementia? a. Aphasia NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. Under most conditions, adult patients should be able to repeat forward a series of

_____________ numbers. ANS:

five to eight 5-8 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Remembering (Knowledge) 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:

2 to 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 08: Growth, Measurement, and Nutrition Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i 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) 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

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Under the influence of the hypothalamus, pituitary gland, and gonads, developmental changes of puberty are established. DIF: Cognitive Level: Understanding (Comprehension) 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) 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Gender-specific skeletal differences first occur during: a. the second stage of fetal development. b. late infancy. c. early childhood. d. adolescence. ANS: D

GTB.C During adolescence, femalesNdevelop pelvis URSIaNwider OMand 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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

Most adult obesity begins in adolescence. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The legs are the fastest growing body part during: a. early infancy. b. late infancy. c. childhood. d. early adulthood.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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 youngerNthan 16 years,B.C or lessMthan 2 years from menarche, may still be UR SING T weight O gains during pregnancy to achieve an in their growth spurt. They may require higher 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. The rate of weight gain during pregnancy is expected to be: a. greatest in the first trimester.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. During a preventive healthcare 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 hi a i i i h he . He e a ea aigh a d a ig ed. Whe add e i g M . G. present concerns, it is most important to inquire about: a. the number of pregnancies. b. he a e heigh . 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 di k , i i i a de e i e he a ie heigh a d eigh a hi age a a ba e i e for future trending. DIF: Cognitive Level: Applying NU(Application) RSINGTB.COM OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. T a. b. c. d.

e i a e a i di id a f a e i e, he e a i e h d ea e: skull circumference. the length from the olecranon process to the acromion process. elbow breadth. hip circumference.

ANS: C

Wi h he a ie 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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 weightMby 4 to 5 months of age and triple their NURtheir INbirth GTB.C S O are heavier after the first 6 months of birth weight by 12 months of age. Formula-fed infants 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. T

ea e head ci c fe e ce, he a e i occipital protuberance and the: a. supraorbital prominence. b. brow line. c. nasal bridge.

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d he chi d head a he

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. chin. ANS: A

The ea i g a e h d be g a ed a d he chi d head a he cci i a 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Be ee 5 a d 24 h f ife, he i fa che ci c 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.

fe e ce i

ANS: A

Be ee he age f 5 h a d 2 ea , he i fa che ci c fe e ce h d c approximate the head circumference; the ratio should be monitored so that possible microcephaly can be identified.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. I c i ica ac ice, he Ba a d A e e T i ed a. length. NURSINGTB.COM b. weight. c. lung maturity. d. gestational age.

a e

a e b

ANS: D

The Ballard Assessment Tool assesses six physical and six neuromuscular characteristics and i ad i i e ed i hi 36 h f bi h c fi he e b ge a i a age. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which situation 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Which statement 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. NUTanner RSINbreast GTB.C M d. Menarche should occur by stageO2. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 26. 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. 3 pounds c. 2 pounds d. 4 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 around 0.45 kg (1 pound) per week. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. 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) NURSI NGMSC: TB.C OM OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation 28. R

d face, ea ic a fa , h area are associated with: a. infantile hydrocephalus. b. acromegaly. c. Cushing syndrome. d. achondroplasia.

e ig e a i

, a d b ffa

ce ica

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. 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. Thiamin c. Calcium d. Fat

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

ANS: D

Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. Iron, thiamin, and calcium are minerals. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Which 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Which f he f i g i he acc a e ef ec i a. 24-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assay

f a i di id a

d i ake?

ANS: B

INitGhappens, M The food diary is a record ofN intake this method the most accurate URSas TB.COmaking ef ec i f a i di id a f d i ake. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. Laxatives d. Steroids ANS: D

Medications that contribute to weight gain include steroids, oral contraceptives, antidepressants, and insulin. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. 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. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which are signs and symptoms of hydrocephalus? (Select all that apply.) a. Early closed suture lines b. Hyperreflexia Y c. Irritable, poor feeding Y d. Does not meet expected height and weight e. Difficulty holding head up Y f. Rapidly increasing head circumference Y ANS: B, C, E, F

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Signs and symptoms of hydrocephalus include hyperreflexia, difficulty holding head up, irritability, lack of energy, rapidly increasing head circumference, and poor feeding. Early closed suture lines and inability to meet expected height and weight do not indicate hydrocephalus. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. An 11-year- d b

i b gh i f a a heigh i 60 i che . Y ec Ma fa _______________ inches.

a d

h ica e a i a i e beca e he b

b hi he . The b a span is greater than

ANS:

60 A a ha i g ea e ha a chi d heigh i a cia ed i h Ma fa d e. Chi d e with Marfan syndrome can have cardiovascular problems and should be thoroughly evaluated. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Infants normally increase their birth length by ____% during the first year of life. ANS:

NURSINGTB.COM

Infant length generally increases by 50% in the first year of life. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The term large for gestational age (LGA) indicates that an infant is larger than ____% of

i fa

a he a e

f eek ge a i

ANS:

90 LGA corresponds to an infant whose weight is classified as greater than the 90th percentile. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 09: Skin, Hair, and Nails Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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, thereb enabling the skin to repair damaged surfaces. DIF: Cognitive Level: Remembering (Knowledge) 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,N and calories. INGTofB.C URaSreserve OM DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Leonard brings her newborn infant into the pediatrician s office for a first well-baby

visit. As the healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mrs. Mulligan brings her 16-year-old son into the office for a sports physical examination. As

the healthcare provider, you explain that normal hormone-related changes of adolescence include: a. increased oil production. b. slowed hair growth. c. depleted apocrine glands.NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Brittle nails are typical findings in: a. adolescents.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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 healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 12. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Unusual white areas on the skin may be caused by: a. adrenal disease. b. polycythemia. NURSINGTB.COM c. vitiligo. d. Down syndrome. ANS: C

The absence of melanin produces unpigmented white areas known as vitiligo. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. You are inspecting the lower extremities of a patient and have noted pale, shiny skin of the

lower extremities. This may reflect:

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

systemic disease. a history of vigorous exercise. peptic ulcer disease. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

N R I G B.C M

U Swho N has T comeOto the office for a routine physical 18. Mrs. Bower is a 39-year-old patient examination. As a healthcare provider, you know that the skin temperature is best assessed with the: a. dorsal surface of the e aminer s hand. b. palmar surface of the e aminer s hand. c. ulnar surface of the e aminer s hand. d. pads of the e aminer s fingers. ANS: A

The dorsal surface of the hand is best for estimating temperature variations. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. Telangiectasias refill erratically. Petechiae and purpura do not blanch. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. 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

NURSINGTB.COM

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Skin turgor checks are performed to determine the: a. temperature of the skin. b. hydration status.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Fluorescing lesions are best distinguished using a(n): a. incandescent lamp. b. magnifying glass. c. transilluminator. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 27. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. A single transverse line seenN in the palm of a small child may imply: URSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. Cafe 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 six or more patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. ANS: C

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The presence of six or more 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 cafe 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. Linea nigra is commonly found on the abdomens of: a. infants and children. b. adolescents. c. pregnant patients. d. older adults. ANS: C

NURSINGTB.COM

Pregnant patients commonly develop pigmentation of the abdomen from the symphysis pubis to the top of the fundus in the midline. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. The most common inflammatory skin condition is: a. cutis marmorata. b. eczematous dermatitis. c. intradermal nevus. d. pityriasis rosea. N R I G B.C M ANS: B

U S N T

The most common inflammatory skin disorder is eczematous dermatitis. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. Which 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. recurrence. ANS: A

Unlike other skin conditions, silvery papules and plaques characterize psoriasis. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. A 17-year-old student complains of a rash for 3 da s. You note pale, er thematous oval

plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse s ne t 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

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Which of the following is an ABCDE 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, diameter larger than 6 mm and growing, and evolution. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. The most common cutaneous neoplasm is: a. basal cell carcinoma.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 43. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 44. A 5-year-old child presents with discrete vesicles on an erythematous base 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 ne t action? a. Teach infectious control N measures. R INGTB.COM b. Inquire about other patternsUof S 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 ph sical 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 45. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Impetigo causes intense pruritus, regional lymphadenopathy, and honey-colored exudative crusting as the vesicles or bullae rupture and dry. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 46. You are conducting a preschool examination on a 5-year-old child. Which injury would most

likely raise your suspicion that the child is 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 47. 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

N R I G B.C M

N common T Oform of elder abuse. Physical neglect is described asUtheSmost DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 48. The nurse assesses the nail base angle using the Schamroth technique. Which nail bed shape

indicates a normal expected examination finding? 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which identify the signs and symptoms of basal cell cancer? (Select all that apply.) a. Itching

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. c. d. e.

Reddish patch Starts from a nevi Various clinical forms Macule type

cystic, nodular, pigmented

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 10: Lymphatic System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. Which organ 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) 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 againstNthe microorganisms by phagocytosis. URinvasion SINGTofB.C OM DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mrs. Farrel brings in her 6-year-old son with complaints of a sore throat and fever. As the

healthcare provider, you are concerned about his tonsils and adenoids. Enlarged tonsils and adenoids may obstruct the: a. thoracic duct. b. esophagus. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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)

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

8. 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 ad l s l mph nodes diminish in bo h n mber and si e and are replaced i h more fibrotic and fatty tissues. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation N R I GMSC: B.C M

U S N T

10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Which finding 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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 NURSIduct. GTHodgkin B.COMdisease and lymphoma refer to N 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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 the posterior cervical chain.

usually in

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Serum sickness is usually characterized first by the appearance of: a. lymph node enlargement. b. joint pain. c. urticaria. d. fever. N R I G B.C M ANS: C

U S N T

Urticaria is the first sign of serum sickness, followed by lymphadenopathy, joint pain, fever, and facial edema. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which condition stimulates lymph node enlargement? (Select all that apply.) a. Graves disease b. Lymphangioma c. Esophageal reflux d. Parotid swelling ANS: A, B, D

Lymph node enlargement is stimulated by Graves disease, lymphangioma, and parotid swelling. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 11: Head and Neck Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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 noseNenlarges thyroid GTthe B.C URSINand OM cartilage becomes the largest component of the anterior lar n , kno n as the Adam s apple. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Ms. Galvan is a 22-year-old secretar

ho comes to the clinic ith headaches of 6 eeks 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. Gal an s histor ? 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

N R I G B.C M

U S N best T wayOto examine for: 6. Observation during history taking is the a. head position. b. scalp lice. c. thyroid size. d. tracheal alignment. ANS: A

Head position as well as facial features is 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Torticollis is usually caused by constraint of the newborn in utero or injury during vaginal deli er . The other s mptoms ma be diffic lt to discern beca se 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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 clinician 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Which is the best a to position a patient s neck for palpation of the th roid? a. Flexed away from the side being examined b. Flexed directly forward NURexamined c. Flexed toward the side being SINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

11. Yo are palpating a patient s th roid and find that its broadest dimension meas res 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. The correct a to transill minate an infant s sk ll 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 mo th. ANS: C

The correct techniq e for transill mination of the infant s sk ll is to place the light source tightly against the skull so that no light escapes. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation N R I GMSC: B.C M

U S N T

13. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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.

N R I G B.C M

U S (Comprehension) N T O DIF: Cognitive Level: Understanding OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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 te t re, color, and distrib tion. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 12: Eyes Ball: Seidel G ide

Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A condition that typically develops by the age of 45 years is: a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. ANS: A

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Which finding, 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mr. C s is al ac i is 20/50. This means ha he: a. can see 50% of what the average person sees at 20 feet. b. has perfect vision when tested at 50 feet.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. can see 20% of he le ers on he char 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The cri erion for de ermining he adeq ac of a pa ien s is al 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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 droops, covering more of the iris than does the right. NUReyelid SINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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.

N R I G B.C M

U (Analysis) S N T O DIF: Cognitive Level: Analyzing OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient

to respond with: a. brisk blinking. b. copious tearing. c. pupil dilation.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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 just beneath N R I eye, G B.C M the upper lid. ANS: A

U S N T

The lacrimal gland is located at the lower orbital rim near the inner canthus of the eye. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Opacities of the red reflex may indicate the presence of: a. hypertension. b. hydrocephalus. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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)

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

19. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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 s a e of mac lar degenera ion. When his happens, he pa ien s cen ral ision sho ld be assessed using the Amsler grid. The Snellen E chart measures visual acuity, the litmus test is used for testing pH, and a confrontation examines N R I GtestB.C M peripheral vision.

U S N T

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Which may be suggestive of Down syndrome? a. Drusen bodies b. Papilledema c. Narrow palpebral fissures d. Prominent epicanthal folds ANS: D

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. 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

N R I G B.C M

N T is toOstart by dimming the lights because it The best way to assess the eyesUof S a newborn encourages infants to open their eyes. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. 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 characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which are the signs and symptoms of infant retinoblastoma? (Select all that apply.) a. White reflex NURSINGTB.COM b. Red reflex c. Corneal light reflex d. Absence of a blink reflex e. Autosomal dominant trait f. Drainage from the affected eye g. Visual acuity of 20/500 ANS: A, E

Re inoblas oma in an infan is marked b a charac eris ic hi e refle , also called ca s e e reflex or leukocoria. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 13: Ears, Nose, and Throat Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear

drainage. When examining an infa idd e ea , he e h 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 ha d

abi i e

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with

healthcare information, you will explain that she can expect to experience:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

more nasal stuffiness. a sensitive sense of smell. drooling. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about

current medications. Which medications, listed, are likely to contribute to his hearing loss? NURSINGifTB.C OM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 8. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. When conducting an adult otoscopic examination, you should: a. ii he a ie head ea i g ad . 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 c f ab fi i he a ie ea . Whe a e conducting an adult otoscopic examination, he a ie head h d be i i ed a d he i e h de . H d he ha d e f he R I G B.C M otoscope between the thumb N and index finger, supporting it on the middle finger. There is no U S N T O reason for the patient to keep her or his eyes shut. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. When hearing is evaluated, which cranial nerve is being tested? a. III b. IV c. VIII d. XII

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: C

Cranial nerve VIII, the vestibulocochlear nerve, is associated with hearing. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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 loss, a defect in the inner ear. Otitis N RaSsensorineural INGTB.Chearing OMexternal ear that can cause conductive externa and impacted cerumenU are conditions of the hearing problems. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. You are interviewing a parent whose child has a fever, is pulling at her right ear, and is

i i ab e. Y a k he a e ab he chi d a e i e a d fi d ha he chi d ha a dec ea ed appetite. This additional finding is more suggestive of: a. acute otitis media.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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 NUgloved RSINfingers. G B.C M d. pull the gauze-wrapped tongue to eachTside. O 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 1. Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss.

Which 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 high-frequency 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which 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 N R I G B.COM e. Disorder of the inner ear U S N T 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 14: Chest and Lungs Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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 N above rib. OM INfirst GTB.C URSthe DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Ms. Rudman, age 74 years, has no known health problems or diseases. You are doing a

preventive healthcare history and examination. Which symptom is associated with intrathoracic infection? a. Barrel chest b. Cor pulmonale c. Funnel chest NURSINGTB.COM d. Malodorous breath ANS: D

Intrathoracic infections may make the breath malodorous. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 8. As you take vital signs on Mr. Barrow, age 78 years, you note that his respirations are 40

b ea h / i . He ha bee e i g, a d hi c ai 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.

ega d

M . Ba

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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 NU(Application) RSINGTB.COM OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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. B.COM d. air-filled lung tissue is anNinsulator sound. URSINofGT 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which lung sounds are associated with atelectasis? (Select all that apply.) a. Wheezes b. Ronchi c. Crackles d. Crepitus e. Rales ANS: A, B, C

Wheezes, ronchi, and crackles in varying amounts are associated with atelectasis. DIF: Cognitive Level: Understanding (Comprehension)

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

COMPLETION 1. An Apgar score of __________ is given to the infant who demonstrates irregular respiratory

effort. ANS:

1 The Apgar score of 1 in an infant reflects slow or irregular breathing. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 15: Heart Ball: Seidel G ide

Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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 NURSINGTB.COM 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

4. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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 ofIaNproblem. NURS GTB.CInOmost M adults, the apical impulse will not be visible in the upright, lithotomy, or right lateral recumbent positions. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. A palpable rushing vibration over the base of the heart at the second intercostal space is called

a: a. heave. b. lift. c. thrill.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. A lift along the left sternal border likely the result of: NURisSImost NGTB.COM 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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

N R I G B.C M

U S valves, N T which O indicates the end of systole; it is best S2 marks the closure of the semilunar 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. A condition that is likely to present with dizziness and syncope is: a. bacterial endocarditis. b. hypertension.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 dysrhythmia 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms

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 NU(Application) RSINGTB.COM OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Your patient has been diagnosed with pericarditis. Which 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank e. History of kidney failure f. Result of viral infection g. Result of medications such as procainamide ANS: A, B, E, F, G

Pericarditis may be 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 16: Blood Vessels Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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, low-grade fever, tachycardia, and possibly a positive Homan sign. DIF: Cognitive Level: Applying (Application) MSC: Physiologic Integrity: Reduction of Risk Potential

OBJ: Nursing process

diagnosis

2. The most prominent component of the jugular venous pulse is the: a. a wave. b. c wave. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 3. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 4. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 5. 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 ofNbody warmth in the affected area, and loss of hair over the URSINGTB.COM extremities. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 6. 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) MSC: Physiologic Integrity: Reduction of Risk Potential

OBJ: Nursing process

diagnosis

7. A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud

phenomenon includes which of the following?

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

Vasospasm Digital ischemia with pain Triphasic demarcated skin 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 8. 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 NUfemoral RSINpulse GTB.C palpated simultaneously, if the on the OMleft is absent, or if there is bilateral absence of femoral pulses. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 9. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. To assess a patient s jugular veins, the patient should first be placed in which position? a. Supine b. Semi-Fowler c. Upright d. 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 NURSI(Comprehension) NGMSC: TB.C OM OBJ: Nursing process assessment Physiologic Integrity: Reduction of Risk Potential 12. Observation of hand veins can facilitate the 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 hile 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 13. You are assessing Mr. Z s fluid volume status as a result of heart failure. If our finger

depresses a patient s edematous ankle to a depth of 6 mm, ou should record this pitting as: a. 1+. b. 2+. c. 3+. d. 4+.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 14. 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, suggests a coarctation of the aorta. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 15. In infants or small children, a capillary refill time of 4 seconds: a. is normal. b. indicates hypervolemia. NURSINGTshock. B.COM c. indicates dehydration or hypovolemic 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 16. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 17. 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) 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 e amined to rela the sternocleidomastoid. b. Excessive carotid sinus massage compromise blood flow to the brain. NURSIcan NGcause TB.C OM of the pulse. c. Excessive carotid sinus massage can slowing 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 e amined to rela the sternocleidomastoid muscle. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. Which 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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Gender (women are four times more likely than men to have varicose veins genetic predisposition), tobacco use, increased body mass, age, and history of lower extremity trauma are all risk factors for varicose veins. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 17: Breasts and Axillae Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 2. 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 gene.OOnly NURor M 5% to 10% of women with breast SIBRCA2 NGTB.C 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 5. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 6. A 23-year-old white woman N has R come clinic M because she has missed two menstrual I toGtheB.C

U ShaveN enlarged T O periods. She states that her breasts 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 7. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 8. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 9. 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 NU(Application) RSINGMSC: TB.C OM OBJ: Nursing process assessment Physiologic Integrity: Reduction of Risk Potential 10. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 11. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 12. 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 movable and with well-defined 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, well-delineated 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) OBJ: Nursing process assessment MSC: Health Promotion and Maintenance

NURSINGTB.COM

13. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential 14. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Simultaneous observation of both breasts is essential to detect differences between breast size, symmetry, contour, and skin color. DIF: Cognitive Level: Applying (Application) 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential

N R I G B.C M

U S who N presents T Ofor a routine annual examination. During 2. Ms. Lawson is a 41-year-old patient 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Reduction of Risk Potential

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 18: Abdomen Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. Mrs. James is 7 months pregnant and states that she has de eloped a problem

ith 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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. NUsyndrome. RSINGTB.COM b. one cause of malabsorption 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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. Histor of international tra el and tra eler 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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. NURSINGTB.COM 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 slightl fle ed knees. The other techniques are not helpful because they increase muscle flexion. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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 document 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Integrated Process: Communication and Documentation 7. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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 N R IafterGlistening B.C to M each quadrant for 5 minutes.

U S N T

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. When percussing a spleen, Traube s space is a: a. semilunar region. b. splenic percussion sign. c. left-sided pleural effusion. d. solid mass. ANS: A

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 b the si th ribs superiorl , the midaxillary line laterally, and the left costal margin inferiorly. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. To assess for liver enlargement in the obese person, you should: NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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)

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

14. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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.

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U (Analysis) S N T O DIF: Cognitive Level: Analyzing OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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 likel diagnosis for this child hen our 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

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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 McBurne sign is rebound tenderness at McBurne s point. DIF: Cognitive Level: Analyzing (Analysis) MSC: Physiologic Integrity: Reduction of Risk Potential

OBJ: Nursing process

diagnosis

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 NURSINGTB.COM 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) MSC: Physiologic Integrity: Reduction of Risk Potential

NURSINGTB.COM

OBJ: Nursing process

diagnosis

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 19: Female Genitalia Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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

The labia minora join posteriorly to form the fourchette. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. A cervical polyp usually appears as a: a. grainy area at the ectocervical junction. b. bright red, soft protrusion from the endocervical canal. c. transverse or stellate scar. d. hard granular surface at or near the os. ANS: B

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

NURSINGTB.COM

DIF: Cognitive Level: Understanding (Comprehension) 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) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The vaginal mucosa of a woman of childbearing years should appear: a. smooth and pink. b. moist and excoriated. c. dry and papular. d. transversely rugated. ANS: D

Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The adnexa of the uterus are composed of the: a. corpus and cervix. b. fallopian tubes and ovaries. c. uterosacral and broad ligaments. d. vagina and fundus. ANS: B

The fallopian tubes and ovaries are collectively referred to as the adnexa of the uterus. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

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U Spregnancy N T is called O (the): 7. A bluish color to the cervix during a. McDonald sign. b. Spinnbarkeit. c. Goodell sign. d. Chadwick sign. ANS: D

The Chadwick sign is a bluish color to the cervix during pregnancy. The Goodell sign is an increase in vascularity and softening of the cervix. Spinnbarkeit refers to the quality of elastic mucus during mittelschmerz, and the McDonald sign is fundal flexing on the cervix. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. The pelvic joint that separates most appreciably during late pregnancy is the: a. sacroiliac. b. symphysis. c. sacrococcygeal. d. iliofemoral. ANS: B

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Pregnancy-related cervical changes include: a. flattening and lengthening. b. thinning and reddening. c. hardening and pallor. d. softening and bluish coloring. ANS: D

During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign). DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Mrs. Robinson, a 49-year-old patient, presents to the office complaining of missing her

menstrual period. She asks about menopause. You explain to her that the conventional definition of menopause is: a. the first day of the last menstrual period. b. 1 year with no menses. c. the last day of the last menstrual period. d. the cessation of ovulation. ANS: B

Menopause is defined as 1 year without menses. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank When obtaining history of present illness information for the woman with a vaginal discharge, you should inquire about her douching habits. Douching is not only medically unnecessary but it can also mask, or even worsen, conditions such as bacterial vaginosis or a yeast infection. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 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) 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

N R I G B.C M

N Tof menstrual O There is a relationship betweenUtheSnumber cycles and risk of ovarian cancer. Early menarche and menopause after 50 years of age increase the risk. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. The form of gynecologic cancer that is increased in obese women is: a. vaginal. b. cervical. c. ovarian. d. endometrial. ANS: D

Obesity increases a woman s chance of developing endometrial cancer by twofold to fivefold. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her

daughter s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child s: a. drug ingestion. b. fluid intake. c. risk for sexual abuse.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) 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

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It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water. Although gel lubrication would facilitate speculum introduction, the gel could interfere with cytologic studies. Use of a plastic speculum or opening the blades completely would not facilitate speculum introduction. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 20. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. The presence of a fishy odor after adding potassium hydroxide to a wet mount slide

containing vaginal mucus suggests: a. bacterial vaginosis. b. yeast infection. c. chlamydial infection. d. pregnancy. ANS: A

A positive whiff test suggests bacterial vaginosis. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

N R I G B.C M

U Sis not N part T of the O bimanual examination? 22. The assessment of which structure 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Mrs. Reilly brings her 6-year-old daughter in with complaints of a foul vaginal discharge

noted in her underpants. The most common cause of a foul vaginal discharge in children is a(n): a. accident. b. foreign body. c. infection. d. ruptured hymen. ANS: B

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

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vaginal vault,

you should first: a. insert a pediatric vaginal speculum. b. place the child prone and in the fetal position. c. insert a cotton-tipped applicator and press down. d. pull the labia forward and slightly to the side. ANS: D

Applying anterior labial traction allows the hymenal opening and the interior of the vagina to become visible, almost to the cervix. The presence of a foreign body will be visible with this maneuver. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate

after she fell while riding her bicycle. On inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with: a. chronic masturbation. b. congenital defects. c. acute urinary tract infection. d. sexual abuse. ANS: D

A straddle injury from a bicycle seatIis usually evident NUR GTB.C M over the symphysis pubis; injuries S N O resulting from sexual molestation are generally more posterior and may involve the perineum grossly. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Asking the woman to close the introitus during a pelvic examination is a test for: a. endometriosis. b. rectocele. c. cervical polyps.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Itchy, painful, small red vesicles are typical of: a. condyloma acuminatum. b. condyloma latum. c. herpes simplex lesions. d. syphilitic chancre. ANS: C

Herpetic lesions are painful, itchy red vesicles; condyloma acuminatum are warty lesions on the genitalia; condyloma latum are secondary syphilis lesions that appear as flat, round, or oval papules covered by a gray exudate; and a chancre is a painless ulcer. DIF: Cognitive Level: Understanding (Comprehension) MSC: Physiologic Integrity: Physiologic Adaptation

OBJ: Nursing process—diagnosis

29. A young, sexually active woman comes to the urgent care clinic complaining of suprapubic

abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria and no vaginal discharge or odor. NURASIpelvic GTexamination B.COM is done. She has pain with cervical motion, and you palpate a painful massNover 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) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 20: Male Genitalia Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. While examining an 18-year-old man, you note that his penis and testicles are more darkly

pigmented than the body skin. You should consider this finding to be: a. within normal limits. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone. ANS: A

Darker pigmentation on the penis and testicles, as compared with other body skin, is a normal finding and is not suggestive of a skin fungus, psoriasis, or excessive progesterone. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance.

This is usually: a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes. ANS: B

NURSINGTB.COM

In the uncircumcised male, smegma is formed by the secretion of sebaceous material by the glans and the desquamation of epithelial cells from the prepuce. It appears as a cheesy white substance on the glans and in the fornix of the foreskin. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. It is not usually evidence of a fungal infection, penile carcinoma, or diabetes. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Inspection of the scrotum should reveal: a. lightly pigmented skin. b. two testes per sac. c. smooth scrotal sacs. d. the left scrotal sac lower than the right. ANS: D

The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The skin of the scrotum is more darkly pigmented. The scrotum has one testis per sac. The scrotum has small epidermoid cysts that give it a lumpy appearance. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Expected genitalia changes that occur as men age include that:

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

the ejaculatory volume decreases with age. erections develop more quickly. the viability of sperm increases. the scrotum becomes more pendulous.

ANS: D

Ejaculatory volume increases with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Inspection of the male urethral orifice requires the examiner to: a. ask the patient to bear down. b. insert a small urethral speculum. c. press the glans between the thumb and forefinger. d. transilluminate the penile shaft. ANS: C

Inspection of the urethral orifice is accomplished by pressing the glans between the e a i e h b a d f efi ge . Thi a e e e he li like ifice for further inspection. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and

cannot be easily retracted. You NUshould: RSINGTB.COM a. chart the finding as paraphimosis. b. inquire about previous penile infections. c. retract the foreskin firmly. d. transilluminate the glans. ANS: B

This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. You should not chart this finding as paraphimosis. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. 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)

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

8. Which condition 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mr. L has an unusually thick scrotum, with edema and pitting. He has a history of cardiac

problems. The appearance of his scrotum is most likely a(n): a. congenital defect that has worsened. b. indication of general fluid retention. c. normal consequence of aging. d. complication of the development of mumps. ANS: B

General fluid retention can cause scrotal thickening and pitting edema, and is usually seen as a result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the genitalia, but rather a condition of these related systems. DIF: Cognitive Level: Applying NU(Application) RSINGTB.COM OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. A characteristic related to syphilis or diabetic neuropathy is testicular: a. dropping, with asymmetry. b. enlargement. c. insensitivity to painful stimulation. d. recession into the abdomen. ANS: C

Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. On palpation, a normal vas deferens should feel: a. beaded. b. smooth. c. ridged. d. spongy. ANS: B

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The vas deferens should feel smooth and discrete as it is palpated from the testicle to the inguinal ring. A beaded or lumpy vas deferens might indicate diabetes or the presence of old inflammatory changes. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. A a. b. c. d.

e a e i fa bifid. loose. ridged. smooth.

ill a ea :

ANS: D

The premature male scrotum will appear underdeveloped, smooth, without rugae, and without testes; the full-term infant should have a loose, pendulous scrotum, with rugae and a midline raphe. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. An enlarged painless testicle in an adolescent or adult male may indicate: a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle. ANS: C

N R I G B.C M

U S T a tumor O in the adolescent or adult male. A hard, enlarged, painless testicle can N indicate Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. You palpate a soft, slightly tender mass in the right scrotum of an adult male. You attempt to

reduce the size of the mass, and there is no change in the mass size. Your next assessment maneuver is to: a. use two fingers to attempt to reduce the mass. b. palpate the left scrotum simultaneously. c. lift the right testicle and then compare pain level. d. transilluminate the mass. ANS: D

A soft mass is a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a nonreducible mass should be transilluminated to determine whether it contains fluid and is possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is suspected. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 15. The most common cancer in young men ages 15 to 30 years is: a. testicular. b. penile. c. prostate. d. anal. ANS: A

Because testicular tumors are the most common cancer occurring in young adults, self-examination is encouraged. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. The most emergent cause of testicular pain in a young male is: a. testicular torsion. b. epididymitis. c. tumor. d. hydrocele. ANS: A

Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. An adolescent male is being N seenRforIacute G onset B.CofMleft testicular pain. The pain started 3

U SandNdenies T dysuria O or fever. Your priority action should be hours ago. He complains of nausea 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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

The most common type of hernia in children and young males is an indirect inguinal hernia. DIF: Cognitive Level: Remembering (Knowledge)

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank OBJ: Nursing process

assessment

MSC: Physiologic Integrity: Physiologic Adaptation

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

Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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 NUR(Analysis) SINGMSC: TB.C OM OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation 21. Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably: a. herpetic lesions. b. condylomata. c. molluscum contagiosum. d. chancres. ANS: C

Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not

painful on palpation. The left inguinal canal is without masses. The mass transilluminates with a penlight. This collection of symptoms is consistent with: a. orchitis. b. a hydrocele. c. a rectocele. d. a scrotal hernia. ANS: B

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank A hydrocele is a soft scrotal mass that occurs as a result of fluid accumulation and therefore transilluminates. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal. DIF: Cognitive Level: Analyzing (Analysis) MSC: Physiologic Integrity: Physiologic Adaptation

OBJ: Nursing process

diagnosis

23. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Parents of a 6-year-old boy should be asked if he has: a. erections. b. nocturnal emissions. c. rapid detumescence. d. scrotal swelling. ANS: D

Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The questions about erections are for the older male. The NURSIand GTrapid B.Cdetumescence OM question about nocturnal emissions is N asked of adolescents. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. The male with Peyronie disease will usually complain of: a. painful, inflamed testicles. b. deviation of the penis during erection. c. lack of sexual interest. d. painful lesions of the penis. ANS: B

Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. A cremasteric reflex should result in: a. testicular and scrotal rise on the stroked side. b. penile deviation to the left side. c. bilateral elevation of the scrotum. d. immediate erection of the penis.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: A

On stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should rise on the stroked side. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 21: Anus, Rectum, and Prostate Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal.

Which sign would indicate to the healthcare provider that she has a closed anal passageway? a. Development of a scaphoid abdomen b. Vomiting after her first feeding c. Bleeding from the rectum d. Failure to pass meconium stool ANS: D

Failure to pass meconium stool indicates that a newborn has an imperforate anus. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. 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. NU RSINGTB.COM DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The prostatic sulcus: a. divides the right and left lateral lobes. b. is the site of the seminal vesicle emergence. c. refers to the anterior aspect of the prostate. d. secretes clear viscous mucus. ANS: A

The prostatic sulcus divides the two lateral lobes and is palpated as a shallow groove. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The rectal past medical history of all patients should include inquiry about: a. bowel habits. b. dietary habits. c. hemorrhoid surgery. d. laxative use. ANS: C

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Past medical history should include inquiry about hemorrhoids, spinal cord injury, benign prostatic hypertrophy (BPH), prostate, colorectal, breast, ovarian, or endometrial cancers, and episiotomies of fourth-degree lacerations during delivery. Habits are part of the personal and social history; the use of laxatives is part of the history of the present illness. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The effects of aging on the gastrointestinal system lead to more frequent experiences of: a. constipation. b. prolonged satiety. c. diarrhea. d. prostate glandular atrophy. ANS: A

Older adults experience an elevated pressure threshold for the sensation of rectal distention and are therefore susceptible to constipation. They also experience early satiety, fecal incontinence, and prostate glandular hypertrophy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Factors associated with increased risk of prostate cancer include: a. African descent. b. cigarette smoking. c. a low-fat diet. d. alcoholism. ANS: A

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The incidence rate of prostate cancer is 50% higher for African American men compared with white American men. African American men also have a higher mortality rate. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The caliber of the urinary stream is routine information in the history of: a. adolescents. b. infants. c. older adults. d. sexually active young men. ANS: C

Routine questions about the caliber of the urinary stream and dribbling are directed toward older men because hypertrophy of the prostate gradually impedes urine flow. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Equipment for examination of the anus, rectum, and prostate routinely includes gloves and: a. a hand mirror and gauze. b. a lubricant and penlight. c. slides and normal saline.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. swabs and culture medium. ANS: B

Equipment for the examination includes a penlight, lubricating jelly, gloves, and fecal occult blood testing materials. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Which is a risk factor for colorectal cancer? a. High-fiber diet b. Diet low in animal fats and proteins c. Irish descent d. Inherited BRAC2 mutation ANS: D

History of intestinal polyps is considered a risk factor for colorectal cancer, as are diets low in fiber and high in animal fats and an ethnic background of Ashkenazi Jewish descent. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Nodules found in the peritoneum through the anterior rectal wall: a. are found with bidigital palpation. b. are called shelf lesions. c. are chronic fibrosis. d. are found by having the patient bear down. ANS: B

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Because the anterior rectal wall is in contact with the peritoneum, you may be able to detect the tenderness of peritoneal inflammation and the nodularity of peritoneal metastasis. The nodules called shelf lesions are palpable just above the prostate in males and in the cul-de-sac of females. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience: a. bulging and wrinkling. b. constipation and pallor. c. diarrhea and redness. d. tenderness and inflammation. ANS: D

Tenderness and inflammation to the perianal area may be related to an abscess, fistula, fissure, pilonidal cyst, or pruritus ani. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Palpation of the anal ring is done by: a. bidigital palpation with the thumbs.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank b. inserting the smallest finger into the anus. c. pressing a gauze pad over the anus. d. rotation of the forefinger inside the anus. ANS: D

The anal muscular ring is palpated by rotating the examination finger. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The posterior surface of the prostate can be located by palpation of the: a. anal canal and perineum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. ANS: B

Palpation of the rectal anterior wall facilitates posterior prostate location. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. The cervix may be palpated through the: a. anterior rectal wall. b. internal umbilical wall. c. lateral urethral meatus. d. posterior uterine surface. ANS: A

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In women, the cervix can be palpated through the anterior rectal wall. It feels like a small, round mass. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Yo r pa ien

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

Persistent pencil-shaped stools are indicative of stenosis from scarring or pressure from a mass. DRE should be performed to assess for a mass. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Very light tan or gray stools may indicate: a. upper gastrointestinal bleeding. b. obstructive jaundice.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. lower gastrointestinal bleeding. d. polyposis. ANS: B

Very light tan or gray stools suggest obstructive jaundice. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Tarry black stools should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal tract bleeding. d. prostatic cancer. ANS: C

Upper intestinal tract bleeding results in tarry black stools. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Prostate-specific antigen (PSA) screening is controversial because: a. there are many false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. no data have proved that it decreases mortality. ANS: D

GTB.CO M There are no data confirmingNthat decreases mortality from prostate cancer. URPSA SINscreening DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank Lightly touching the anal opening of an infant should produce a contraction referred to as an anal wink. A negative wink may indicate a lower spinal cord lesion. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Pinworms and Candida may both cause: a. constipation. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. ANS: C

Pinworms and Candida both cause perirectal irritation and itching. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. Thrombosed hemorrhoids are: a. flabby skin sacs. b. red, inflamed, and painful. c. fluctuant soft papules. d. blue, shiny, painful masses. ANS: D

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

N R I G B.C M

S N T O DIF: Cognitive Level: ApplyingU(Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Palpation of a normal prostate in an older adult is likely to feel: a. cool. b. grainy. c. polypoid. d. rubbery. ANS: D

Older men are more likely to experience prostate hypertrophy, which when palpated feels smooth, rubbery, and symmetric. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Mr. Dunn is a 62-year-old man who has presented for a routine annual examination. On

examination of the prostate you note a hard, irregular, painless nodule and obliteration of the median sulcus. These are signs of: a. benign prostatic hypertrophy. b. cancer of the prostate. c. long-standing prostatitis. d. swelling as a result of aging.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank ANS: B

Obliteration of the median sulcus is consistent with organ enlargement; however, the associated findings of a hard, irregular, and painless nodule indicate a cancerous growth. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. The mother brings her 4-year-old to the clinic because the child complains of perianal itching.

As part of your examination you complete a cellulose tape test. The cellulose tape test is used for the detection of: a. enterobiasis. b. carcinoma. c. amebiasis. d. steatorrhea. ANS: A

Enterobiasis (pinworm infestation) is detected by the cellulose tape test. Pinworms are collected by applying tape to the perianal folds and then pressing the tape on a glass slide. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Mr. Sweeney is a 58-year-old man who has presented for a routine annual prostate

examination. On examination, you note a normal prostate gland. Which of the following characteristics should describe the normal prostate? (Select all that apply.) NURSINGTB.COM a. Rubbery consistency b. About 4 cm in diameter c. Fluctuant softness d. Gland protruding 1 cm into the rectum e. Firm, smooth, and slightly movable ANS: B, D, E

The gland should feel like a pencil eraser, firm, smooth, and slightly movable and should be nontender. It has a diameter of 4 cm, with a 1-cm protrusion into the rectum. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 22: Musculoskeletal System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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

The ball-and-socket joint is the joint that has the widest range of motion (e.g., the hip joint). A condyloid joint may only move in two planes. A gliding joint is only able to glide. A saddle joint has no axial rotation. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Spinal vertebrae are separated from each other by: a. bursae. b. tendons. c. disks. d. ligaments. ANS: C

Except for sacral vertebrae, the NUspinal RSINvertebrae GTB.Care OMseparated from one another by disks. Spinal movement is achieved by paraspinous muscles, tendons, and ligaments. Bursae are located in the knee, elbow, shoulder, and hip. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The joint where the humerus, radius, and ulna articulate is the: a. wrist. b. elbow. c. shoulder. d. clavicle. ANS: B

The elbow is the site where the humerus, radius, and ulna meet. The wrist is made up of the radius and the carpal bones of the hand. The shoulder is made up of the humerus and scapula. The clavicle connects to the scapula but not to the humerus. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The articulation of the radius and carpal bones is the: a. wrist. b. elbow. c. shoulder.

NURSINGTB.COM

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. clavicle. ANS: A

The joint comprising the radius and carpal bones is called the wrist. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. The tibia, fibula, and talus articulate to form the: a. ankle. b. knee. c. hip. d. pelvis. ANS: A

The tibia, fibula, and talus (or heel) join to form the ankle. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Long bones in children have growth plates known as: a. epiphyses. b. epicondyles. c. synovium. d. fossae. ANS: A

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

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DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are the result

of: a. b. c. d.

decreased mineral deposition. increased hormone secretion. uterine enlargement. gait changes.

ANS: B

Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Skeletal changes in older adults are the result of: a. increased bone deposition. b. increased bone resorption. c. decreased bone deposition. d. decreased bone resorption. ANS: B

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank With age, the skeletal system changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. The family history for a patient with joint pain should include information about siblings with: a. trauma to the skeletal system. b. chronic atopic dermatitis. c. genetic disorders. d. obesity. ANS: C

An important history to obtain for a patient with joint pain would be family history of genetic disorders, such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, and hypercalciuria. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Risk factors for sports-related injuries include: a. competing in colder climates. b. previous fracture. c. history of recent weight loss. d. failure to warm up before activity. ANS: D

Failure to warm up before exercise factorMfor sports-related injuries. Climate, N RSisIone G risk B.C O risk factors for sports-related injuries. previous fractures, and weight U loss areNnotTas strong DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Light skin and thin body habitus are risk factors for: a. rheumatoid arthritis. b. osteoarthritis. c. congenital bony defects. d. osteoporosis. ANS: D

People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, and bony defects are not found to have a correlation with light skin and small frame. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Inquiry about nocturnal muscle spasms would be most significant when taking the

musculoskeletal history of: a. adolescents. b. infants. c. older adults.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. middle-age adults. ANS: C

History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals, or electrolytes or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. The musculoskeletal examination should begin when: a. the patient enters the examination room. b. during the collection of subjective data. c. when height is measured. d. when joint mobility is assessed. ANS: A

When the patient first walks in the room, the examiner should be observing his or her gait and posture as part of the musculoskeletal examination. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Fa cic la i cc a. venous return. b. motor neuron. c. strength. d. tendon.

af e i j

a m cle :

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ANS: B

Fasciculations can often be visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. The physical assessment technique most frequently used to assess joint symmetry is: a. inspection. b. palpation. c. percussion. d. the use of joint calipers. ANS: A

The assessment technique most commonly used to assess joint symmetry is inspection. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. A goniometer is used to assess:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. b. c. d.

bone maturity. joint proportions. range of motion. muscle strength.

ANS: C

The angle of a joint can be accurately measured by using a goniometer. A goniometer is used when the joint range of motion is beyond normal limits. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. When palpating joints, crepitus may occur when: a. irregular bony surfaces rub together. b. supporting muscles are excessively spastic. c. joints are excessively lax. d. there is excess fluid within the synovial membrane. ANS: A

Crepitus is felt or heard when irregular bony surfaces rub together. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. The temporomandibular joint is palpated: a. under the mandible, anterior to the sternocleidomastoid muscle. b. above the mandible at midline. c. anterior to the tragus. NURSINGTB.COM d. at the mastoid process. ANS: C

The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. The temporalis and masseter muscles are evaluated by: a. having the patient shrug his or her shoulders. b. having the patient clench his or her teeth. c. asking the patient to fully extend his or her neck. d. a i el e i g he a ie ja . ANS: B

Having the patient to bite down and clench their teeth is the method for evaluating the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. The strength of the trapezius muscle is evaluated by having the patient:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank a. clench his or her teeth during muscle palpation. b. h hi he head agai he e ami e ha d. c. straighten his or her leg with examiner opposition. d. uncross his or her legs with examiner resistance. ANS: B

Having the patient apply opposite force with differing head motions, against the exami e hand, assesses the sternocleidomastoid and trapezius muscles. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. Expected normal findings during the inspection of spinal alignment include: a. asymmetric skin folds at the neck. b. slight right-sided scapular elevation. c. concave lumbar curve. d. the head positioned superiorly to the gluteal cleft. ANS: D

S i al alig me i c ide ed i hi mal limi he he a ie head i i i ed directly over the gluteal cleft. The skin folds should be symmetric, the scapulae are at even heights, and both the cervical and lumbar curves are convex. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. A common finding in markedly obese patients and pregnant women is: a. kyphosis. NURSINGTB.COM b. lordosis. c. paraphimosis. d. scoliosis. ANS: B

Bowing of the back, or lordosis, is more commonly found in pregnant women or obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults. Paraphimosis is a penile condition. Scoliosis is more commonly seen in teenagers. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. A wheelchair-dependent older woman would most likely develop skin breakdown at: a. C7. b. the iliac crests. c. L4. d. the gibbus. ANS: D

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. When a patient abducts an arm and the ipsilateral scapula becomes more prominent (winged),

this usually means that: a. there has been an injury to the nerve of the anterior serratus muscle. b. one of the clavicles has been fractured. c. there is a unilateral trapezius muscle separation. d. one shoulder is dislocated. ANS: A

If the long thoracic nerve is damaged or bruised, it can cause paralysis of the serratus anterior muscle and winging of the scapula, or shoulder blade. This is not a symptom of a fractured clavicle or trapezius muscle separation. A dislocated NURSING B.COMshoulder would result in a hollowing T effect. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When the shoulder contour is asymmetric and one shoulder has hollows in the rounding

contour, you would suspect: a. kyphosis. b. fractured scapula. c. a dislocated shoulder. d. muscle wasting. ANS: C

Asymmetric contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting and a scapular fracture do not present with these symptoms. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Ulnar deviation and swan neck deformities are characteristics of: a. rheumatoid arthritis. b. osteoarthritis. c. osteoporosis.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. congenital defects. ANS: A

Deviation of the fingers toward the ulnar side and swan neck deformities are classic symptoms of rheumatoid arthritis. Osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. A finding that is indicative of osteoarthritis is (are): a. swan neck deformities. b. Bouchard nodes. c. ganglions. d. Heberden nodes. ANS: D

Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities; ganglions are present in nerve conditions. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. Carpal tunnel syndrome would result in: a. a negative Tinel sign. b. a negative Phalen test. N R I G B.C M U S N T O c. reduced abduction of the thumb. d. palm tingling. ANS: C

Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, positive Phalen test, reduced abduction of the thumb, and sparing of palm tingling. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Cardinal signs for rheumatoid disorders include which of the following? (Select all that

apply.) a. Gradual onset b. Weakness that is usually localized and not severe c. Coarse crepitus on motion d. Joint tenderness e. Sleep disturbance ANS: A, D, E

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank DIF: Cognitive Level: Analyzing (Analysis) 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 23: Neurologic System Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

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) 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

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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) 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Cerebrospinal fluid serves as a:

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) OBJ: Nursing process assessment Physiologic Integrity: Physiologic Adaptation N R I GMSC: B.C M

U S N T

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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN)

requires further evaluation? NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. 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. pathway NURSINGNerve M and spinal accessory area refer to TB.C nerve routes. Cutaneous zone refers to a skin areaOthat transmits fine mechanical information and normal exogenous thermal information at the same time. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Which is the technique most often used for evaluating the neurologic system? a. Auscultation b. Inspection c. Palpation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. 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. ANS: D

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

18. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to

side hile s a ing his r nk. Yo a. dystonic ataxia. b. cerebellar ataxia. c. steppage gait. d. tabetic stamping.

o ld doc men Mr. B s pa ern as:

ANS: B

A cerebellar gai (cerebellar a a ia) occ rs hen he pa ien s fee are ide-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 andOthe NURS INaGslap M patient is unable to walk on the heels. TB.C 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 20. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 21. Vibratory sensory testing should be routinely done for the patient with: a. Parkinson disease. b. diabetes. c. cerebral palsy.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 22. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 23. When you ask a patient to close his or her eyes and identify an object placed in the hand, you

are evaluating: a. stereognosis. NURSINGTB.COM 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. Graphes hesia es s he pa ien s abili o iden if he fig re being dra n 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 24. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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-poin discrimina ion assess a person s abili o discern he n mber of pinpoin s and their location. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 25. Which condition 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 26. To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested? a. Triceps b. Patellar c. Biceps NURSINGTB.COM d. Achilles ANS: B

To assess spinal levels L2-4, 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 27. 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 monofilamen is placed on se eral smoo h spo s of he pa ien s plan ar foo for seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

28. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 29. 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

Tes he ankle clon s hen refle es are h perac i e. S ppor he pa ien s knee in a fle ed 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) OBJ: Nursing process assessment SafeMand Effective Care: Management of Care N R I GMSC: B.C

U S N T

30. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 31. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 32. Cranial nerve XII may be assessed in an infant by: a. a ching he infan s facial e pressions hen cr ing. b. observing the infant suck and swallow. c. clapping hands and watching the infant blink. d. obser ing he infan s roo ing refle . 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 ong e o rise in a midline posi ion. Wa ching he infan s facial e pressions hen cr ing 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 33. 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. NURSINGTB.COM 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 34. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 35. 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 36. Which 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. Reduction in upward gaze ANS: B

Bilateral pillrolling is indicative of Parkinson disease; the other choices are expected findings with aging.

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DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 37. Which condition 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 life-threatening illness if not rapidly treated with appropriate antibiotics. All the other diseases are neurologic disorders not treatable by antibiotics. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 38. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 39. 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 he brain s hi e ma er, leading o obs r c ed ransmission of ner e imp lses 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.

NURSI(Comprehension) NGTB.COM DIF: Cognitive Level: Understanding OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care 40. 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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process assessment MSC: Safe and Effective Care: Management of Care

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 24: Sports Participation Evaluation Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i 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) 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 N with and/or URthe SIathlete NGTB.C OMparents. In addition, the written report is distributed. DIF: Cognitive Level: Analyzing (Analysis) 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) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) 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. NURSINGTB.COM 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) 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) OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance

N R I G B.C M

U asSpartNofTa sportsOphysical examination. You hear a murmur 10. You are auscultating heart tones 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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) OBJ: Nursing process—assessment MSC: Health Promotion and Maintenance

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 25: Putting it All Together Ball: Seidel G ide Ph ical E a i a i

, 9 h Edi i

MULTIPLE CHOICE 1. Which is true regarding the relationship between the examiner and patient? a. I i he e a i e 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 ig ed. The e a i e h d ee he a ie i f ed, b i i he e a i e responsibility to help the patient understand that he or she is qualified to make healthcare 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 2. Which e a i e beha i d he i i i e a ie a. Assume a busy and rushed attitude. b. Convey your own feelings of discomfort. G B.COM UR SIN c. Keep the patient waiting N for more thanT30 minutes. d. See i f a i ab he a ie be .

di a i fac i

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) 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. i g ab he a ie di c f d. moving briskly to completion.

ANS: A

Ac edgi g he a ie 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) 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) 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. Va ida e he a ie ified c ce . ANS: D

The examiner needs to learn a gentle and balanced demeanor. By showing concern for the a ie fee i g , gai he a ieI G B.C ; gi i M g ici ed ad ice can cause the patient N R O to lose trust in the relationship.U S N T DIF: Cognitive Level: Understanding (Comprehension) 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. Le ge he i . b. I h e i ea e. c. Le e e ha I ca d f . d. Te e ab e f. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 7. Which patient characteristic is most likely to limit patient reliability during history taking? a. The a ie ea ed IQ i ab e a e age. b. The patient is alert and oriented to time and place.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank c. The patient is depressed. d. The patient speaks the same language as examiner. ANS: C

E i a c ai ca i i a a ie e iabi i a a hi ia . La g age barriers, c a ba ie , a d a e i e c a e a ie ca a affec a a ie abi i be a h gh hi ia . A he he i d i i a a ie e iabi i . DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 8. The reliability of health-related findings and observations is the responsibility of the: a. patient. b. professional and medical assistants. c. attending clinician. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 9. Which is most likely to enhance examiner reliability? a. The examiner who seeks input from others. b. The examiner is uncomfortable with his or her own skills. c. The examiner believes that orIsheGmust always be correct. N heRS NandTB.C OM d. The examiner prejudges theUpatient 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 10. Which statement 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 12. Which data is 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 13. The sequence of the physicalNexamination I G should B.C beMindividualized to: URS a. minimize the number of times thatNtheTpatientO 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 c e e he a ie e eg . DIF: Cognitive Level: Applying (Application) 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 e a i i g ab e. I he i i g ii , ca e a i e he a ie a ei a d ei upper trunk and head, which comprise most of the focused assessments.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) 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) 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 the humerus. N Rcondyle I G ofB.C M

U S N T

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 17. Which 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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) 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

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Asking the supine patient to raise his or her head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. DIF: Cognitive Level: Applying (Application) 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) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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 a ie be d e a he ai a d ca a e a a ie a ge f i . DIF: Cognitive Level: Understanding (Comprehension) 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 NURSINGTB.COM 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) 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

T de e i e ge a i a age, a he e f he fee . Bef e 36 ee gestation, only e a e e c ea e a e e e ; b 40 ee ge a i , a c ea e a e e e 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

26. T

e a chi d c eai d i g e amination, 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 27. Which 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) OBJ: Nursing process assessment Physiologic Integrity: Basic Care and Comfort N R I GMSC: B.C M

U S N T

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. determine 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) 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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 endpiece of the eh c e b f a h igh . DIF: Cognitive Level: Applying (Application) 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

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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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 32. When you attempt to move a 10-month- d chi d f

he e a i a i

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. e f he e a i a i hi e he chi d i i he he a . d. defer the examination until another day. ANS: C

The a e a i a g ea e a i a i ab e beca e i he he chi d fee e a ea e a d i 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

33. When conducting a geriatric assessment, keep in mind that basic activities of daily living

(ADL) include: a. bathing. b. housekeeping. c. medication compliance. d. communication skills. ANS: A

Basic ADL include bathing, dressing, toileting, ambulating, and feeding. All the other options represent instrumental ADL. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 34. Whe e a i i g a diffic

a ie , i i be

hich e

he e a i a i

room? a. The clinician b. Pa ie a chi d e c. An interpreter d. A chaperone ANS: D

A cha e e f diffic patients ensures the examination goes smoothly. The chaperone may also assist with patient positioning. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment Physiologic Integrity: Basic Care and Comfort N R I GMSC: B.C M

U S N T

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 a d i e ac i ca ide a g ea dea f i f a i ab he i di id a i de e de functional capacity. Attention should be given to self-care activities and instrumental activities. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 36. 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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank The child playing on the floor offers an opportunity to evaluate the musculoskeletal and e gic e b i g he chi d c di a i f ac i i ie , ch a he h i ga ball, drawing, coloring, walking, and jumping. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 37. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 38. For a routine physical examination, which equipment is not necessary? a. A penlight b. A measuring tape c. Examination gloves d. A monofilament ANS: D

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A penlight, measuring tape, and examination gloves are needed for every routine examination; a monofilament is not. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 39. 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 40. Which action should the nurse take before auscultating bowel sounds in an 18-month-old

child? a. Stand to the left of the child b. Palpate the abdomen c. Loosen the diaper

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank d. Position the child prone ANS: C

The dia e be e ed he e i ab e ace he e h c e he chi d a d he dia e . P aci g he e h c e he chi d dia e i i e fe e i h he ability to hear the bowel sounds.

i e

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 41. Which position is most likely the most comfortable for a patient who is 6 months pregnant? a. Side-lying b. Lithotomy c. Prone d. Flexed-knee ANS: A

Late in pregnancy, the patient may find it difficult to assume the lithotomy or supine position. The nurse should position pillows so that the patient is in the side-lying position as much as possible during the examination. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort 42. Wha i he b -bag a ach i ega d e a i i g a de ad ? a. The a ie s stool sample is brought to the examination in a brown bag. b. The a ie edica i a e b gh he e a i a i i a b bag. c. The a ie s change of clothes to theMexamination in a brown bag. NURSisIbrought GTB.C d. The a ie a i i e de ice i b N gh heOe a i a i i a b bag. ANS: B

Older adults are often asked to bring in all of their medications, prescription and non-prescription, from all healthcare providers to their physical examination appointment. Thi i efe ed a he b -bag a ach. DIF: Cognitive Level: Understanding (Comprehension) 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

a ie i ab e h g he h de agai he e a i e ha d d ring 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) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 2. Ms. Stein visits the nurse practitioner for an annual examination. The nurse practitioner tests

M . S ei _______.

g ef

e e

a d

e g h. The

ac i i

e i a e i g CN

ANS:

XII Cranial nerve XII enables the patient to demonstrate tongue movement and strength. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Chapter 26: Emergency or Life-Threatening Situations Ball: Seidel G ide Ph ical E a i a i , 9 h Edi i MULTIPLE CHOICE 1. During initial ABCDE assessments of life-threatening conditions, D (disability) in neurologic

stat s is assessed b 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 responsi eness to stim li. DIF: Cognitive Level: Remembering (Knowledge) 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

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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) 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 temperat re. 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 temperat re 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) OBJ: Nursing process implementing MSC: Safe and Effective Care: Management of Care

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 4. The term status epilepticus is defined as: a. convulsive activity uncontrolled by medication. b. nonconvulsive brain wave disturbance, with psychomotor dysfunction. c. prolonged seizures that occur without recovery of consciousness. d. seizures that result in hypotension, pallor, and prolonged diaphoresis. ANS: C

Status epilepticus is a prolonged seizure or series of seizures that occur without recovery of consciousness. DIF: Cognitive Level: Remembering (Knowledge) 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 NUR(Analysis) SINGTB.COM MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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) 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

N R I G B.C M

S N T O If trauma above the clavicle is U 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) 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) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) 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 r bbing together. A foreign bod co ld obstr ct the patient s air a , prod cing stridor, or a bark may be heard with an obstructed airway. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process assessment MSC: Physiologic Integrity: Basic Care and Comfort

N R I G B.C M

U nose S Nor T 13. Clear or amber drainage from the ears of O 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Applying (Application) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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) 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 wouldNbe R most important B.CtoObegin M secondary assessment of cerebral U SIsNleGT perf sion b determining the patient el of conscio sness. DIF: Cognitive Level: Applying (Application) 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 is determined. The level of consciousness is determined, and the Glasgow Coma Scale is scored as indicated. DIF: Cognitive Level: Understanding (Comprehension) 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.

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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 life-threatening 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) MSC: Physiologic Integrity: Basic N RCareIandGComfort B.C

U S N T

OBJ: Nursing process

diagnosis

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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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

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Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

DIF: Cognitive Level: Remembering (Knowledge) 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) 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 pinkNfrothy sputum. Bleeding GTB.C M ulcer symptoms are coffee grounds URupper SINabdomen. OMyocardial emesis with gnawing pain in the 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

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.

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planning

Seidel's Guide to Physical Examination 9th Edition Ball Test Bank 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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 dysrhythmias 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) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

27. The approximate expected systolic blood pressure for a child older than 1 year is: a. 120 + child s age in ears. N R I G B.COM b. 80 + child s age in ears. U S N T c. 120 ?- child s age in ears. d. 80 + (the child s age in ears). ANS: D

Use the eq ation 80 + (the child s age in ears) to calc late the e pected s stolic blood pressure for a child older than 1 year. DIF: Cognitive Level: Remembering (Knowledge) MSC: Physiologic Integrity: Basic Care and Comfort

OBJ: Nursing process

diagnosis

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) OBJ: Nursing process implementing MSC: Physiologic Integrity: Basic Care and Comfort

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