Cultural Competence in Healthcare: Understanding Patients as Individuals, Exams of Nursing

Download Cultural Competence in Healthcare: Understanding Patients as Individuals and more Exams Nursing in PDF only on Docsity! P a g e 1 | 413 01: The History and Interviewing Process Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which question would be considered a ―leading question? a. ―Please describe any associated symptoms with your headaches? b. ―You don't get headaches often, do you? c. ―What activities affect the severity of your headaches? d. ―What times of the day are your headaches the most severe? e. ―What worries you most about your headache? ANS: B This question would limit the information in the patient's answer. The other choices allow the patient more discretion about the extent of an answer. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient's language? a. Ask a person unfamiliar with the patient to translate. b. Have a friend of the patient translate. c. Ask simple leading questions that the patient may understand. d. Use a neighbor as translator. e. Involve the family with the translation. ANS: A NURS When you do not speak the patient's language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased. 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 technique is most likely to result in the patient's understanding of questions? a. Use phrases that are commonly used by other patients in the area. b. Use the patient's own terms if possible. P a g e 2 | 413 U S N T NURS c. Use language that keeps the patient from being expansive in his or her answer. d. Use proper medical and technical terminology. e. Use the simplest language possible. ANS: B To ensure that your questions have been correctly understood, be clear, and explicit while using the patient's idiom and level of understanding. TOP: Discipline: Behavioral Science MSC: Organ System: General 5. A patient becomes restless during the history and says, ―I don't have time for all of this conversation. I've got to get back to work.‖ Your most appropriate response would be to: a. stop using open-ended questions and become more direct. b. ask another open-ended question and insist on an answer. c. ask questions about his anger and move closer to him. d. acknowledge his anger and proceed with the history and examination. e. ignore his displeasure and become more assertive about getting answers. ANS: D This is the only answer that resists the tendency for patient manipulation, pursues the information, and confronts the patient's anger. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. When questioning a patient regarding alcohol intake, she tells you that she is ―only a social drinker.‖ Which initial response is appropriate? a. ―I'm glad that you are a responsible drinker.‖ b. ―Many people who are reNallyRalcIohoGlic sBay.tCheyMare social drinkers.‖ c. ―What amount and what kind of alcohol do you drink in a week?‖ d. ―If you only drink socially, you won't need to worry about always having a designated driver.‖ e. ―Do the other people in your household consume alcohol?‖ ANS: C This answer clarifies the patient's own term without asking a leading question or being judgmental. TOP: Discipline: Behavioral Science MSC: Organ System: General 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. ―Can you describe the pain?‖ b. ―The pain doesn't radiate to your arm, does it?‖ c. ―Have you been treated for anxiety before?‖ d. ―Does your father have heart disease?‖ e. ―Are the pains worse after you eat?‖ ANS: A Initially, an open-ended question is a more appropriate response. ―Can you describe the pain?‖ is an open-ended question that offers clues to the chief concern. P a g e 5 | 413 NURS To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient's family history and with the social history are incorrect because gathering data about the chief concern is the initial step. 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. ―Do you have any particular sexual likes or dislikes?‖ b. ―Do you have any worries or concerns regarding your sex life?‖ c. ―How often do you have intercourse and with whom?‖ d. ―Do you have any reason to think you may have been exposed to a sexually transmitted infection?‖ e. ―What sexually transmitted diseases have you had in the past?‖ ANS: B When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient's feelings about the issue. 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. avoided for fear of offending the woman's partner. c. conducted only in cases in which there is a history of abuse. d. used only when the patienNtUisRoSbvIioNuGslTyBbe.inCgOvMictimized. 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-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to: a. screen the child for sexual abuse. P a g e 6 | 413 U S N T O NURS b. ask the child to be seated on the examination table so you can talk to her father. c. explain to the child that you will not hurt her and that she will have to trust you. d. ask the father to persuade the child to cooperate with you. e. leave the child sitting in the father's lap while you talk to the father. ANS: E Interaction with children must be modified according to age and in a manner that promotes trust. 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 typical of adolescence and pertinent to Tom's health? a. Attachment to parents b. Tendency to give too much information c. Low peer support needs d. Propensity for risk taking e. High self-esteem ANS: D Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information. TOP: Discipline: Behavioral Science MSC: Organ System: General 20. Pain is difficult to assess in older adults because: a. their histories are usuallyNunrReliaIble.G B.C M 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 functional assessment is an assessment of a patient's mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living. TOP: Discipline: Behavioral Science MSC: Organ System: General P a g e 7 | 413 U S N NURS 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 draftedNfoRr theIpuGrposBe.oCf obMtaining: 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 P a g e 10 | 413 NURS 7. A person's definition of illness is likely to be most influenced by: a. race. b. ritual. c. enculturation. d. age group. e. socioeconomic class. ANS: C The definition of ―ill‖ is determined in large part by the 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, Native Americans, Asians, and Arabs is Western medicine's attempt to: a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. use herbal remedies and rituals. e. promote balance in an individual's life. ANS: B A more scientific approach to 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. TOP: Discipline: Behavioral SNciUenRceSINGMTSBC.: OCrOgaMn 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 good, some bad—that must be kept in balance if we are to remain well. TOP: Discipline: Behavioral Science 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. P a g e 11 | 413 NURS 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 purpose of understanding the patient's culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. TOP: Discipline: Behavioral Science 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 beNhaUvRioSr. INGTB.COM 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. consider the health literacy of one's patients. 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 exclusion of a patient's friends, partner, or family members. It is important in reducing 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. Ability to recognize 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. Meeting patients ―where they are‖ without judgment P a g e 12 | 413 NURS e. Genuine interest in understanding our patients' belief systems and lives 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 NURS P a g e 15 | 413 NURS 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 percuNssUioRnStoInNesGaTreBh.eaCrdOoMver the liver. 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 P a g e 16 | 413 NURS 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. NURS 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. P a g e 17 | 413 U S N T O NURS 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 weight should be calibrated: a. when the patient tells you the weight is not correct. b. by a qualified technician at regularly scheduled intervals. c. each time it is used. d. when necessary, with the patient standing on the scale. e. only by the manufacturer. ANS: C Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. 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, with the examiner's hands under the infant's axilla b. Supine on a measuring board c. While being held by a parent d. In the lateral position witNh thRe toIes aGgainBst.aCmeMasuring board 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 apply the stethoscope's bell endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece. P a g e 20 | 413 NURS 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. NURSIN GTB.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 P a g e 21 | 413 NURS Chapter 04: Clinical Reasoning Ball: Seidel’s Guide to Physical Examination, 9th Edition 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 symptoms associated with each of patient's concerns as well as abnormalities discovered 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. usually ―red herrings.‖ ANS: A NURS New findings of unknown causes are added to the problem list, but do not let them become a ―red herring‖ that distracts your attention from the central issues. 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. P a g e 22 | 413 U S N T NURS 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 wNho Rdo nIot hGaveBth.eCdisMease. 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 P a g e 25 | 413 NURS Chapter 05: Documentation Ball: Seidel’s Guide to Physical Examination, 9th Edition 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 NURS 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. P a g e 26 | 413 NURS 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 the following is an example of a problem requiring recording on the patient's problem list? a. Common age variations b. Expected findings c. Findings of unknown origin d. Minor variations e. Only findings that have a clear etiology ANS: C Any problem is worth noting on the patient problem list even if the etiology or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as problems. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. d. plan. e. laboratory data. ANS: C NURS 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. TOP: Discipline: Behavioral Science 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 P a g e 27 | 413 NURS 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 effect of the chief concern on the patient's lifestyle is recorded in which section of the medical record? a. Chief complaint b. History of present illness c. Past medical history d. General patient information e. Social history ANS: B The effect of the patient's complaint on his or her current everyday lifestyle or work performance is recorded in the history of present illness. TOP: Discipline: Behavioral SNciUenRceSINGMTSBC.: OCrOgaMn System: General 10. The patient's perceived disabilities and functional limitations are recorded in the: a. problem list. b. general patient information. c. social history. d. review of systems. e. past medical history. ANS: E Past medical history contains information about the patient's lifetime as well as disabilities or functional limitations that alter activities of daily living. 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. P a g e 30 | 413 NURS e. Inspection ANS: E Physical assessment for all systems begins with inspection. TOP: Discipline: Behavioral Science MSC: Organ System: General 20. Regarding another provider's documented work, it: a. is not relevant in a legal proceeding. b. will not affect clinical decisions. c. may be copied verbatim into your documentation. d. must be attributed to the source if entered. e. does not affect patient care. ANS: D It is unacceptable to copy other providers' documented work (e.g., history taken, examination performed, or thought processes outlined) and enter it into your own documentation as if you did the work. Text copied from another person's note must always be attributed to the source. This is not only an important concept in a legal proceeding, but it is also critical for safe patient care. 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 ANS: B NURS The Joint Commission has identified ―improving communications among caregivers‖ as a patient safety goal. Certain abbreviations have been placed on a ―do not use‖ list when an error in misreading the abbreviation could cause harm. All of the above abbreviations are on the ―do not use‖ list. TOP: Discipline: Behavioral Science MSC: Organ System: General P a g e 31 | 413 NURS Chapter 06: Vital Signs and Pain Assessment Ball: Seidel’s Guide to Physical Examination, 9th Edition 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. NURS 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. P a g e 32 | 413 U S N T O NURS 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 nondescriptive ―belly pain.‖ Your next action should be to ask him to: a. point a finger to the spot that hurts. b. draw a circle around the area that hurts. c. use a metaphor to describe the pain. d. identify what makes the pNainRwoIrse.G B.C M e. allow him to use a ―pain-o-meter.‖ ANS: A Asking the child to point to the area of pain can help communicate a more precise location. The other choices are not appropriate for the age of the child. 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. P a g e 35 | 413 NURS 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. e. heart disease. ANS: C NURS 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 systolic blood pressure should be less than 120 + the patient’s age is no longer the acceptable definition. TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular P a g e 36 | 413 NURS 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 NURS P a g e 37 | 413 NURS Chapter 07: Mental Status Ball: Seidel’s Guide to Physical Examination, 9th Edition 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 NURS 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. P a g e 40 | 413 NURS 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. d. abstract reasoning. NURS 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 P a g e 41 | 413 NURS 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: NeurosciencNe URSINGMTSBC.: COrOgaMn 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 P a g e 42 | 413 NURS 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 NURS 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 P a g e 45 | 413 NURS b. arm span. c. head circumference. d. gestational age. e. 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. b. early childhood. c. adolescence. d. early adulthood. e. mid-life. ANS: C NURS 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. P a g e 46 | 413 U S N T O NURS 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. N R I G B.C M TOP: Discipline: Behavioral Science MSC: Organ System: Nervous 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 P a g e 47 | 413 NURS 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 MSC: Organ System: Reproductive 16. You should measure the child's head circumference at every health visit until at least age months. a. 3 b. 8 c. 12 d. 18 e. 24 ANS: E Head circumference should be measured at every visit until 2 to 3 years of age. TOP: Discipline: Physiology MSC: Organ System: Reproductive 17. To measure head circumference, the tape is wrapped snugly around the child's head at the occipital protuberance and the: a. supraorbital prominence. b. brow line. c. nasal bridge. d. chin. e. hairline. ANS: A NURS The measuring tape should be snugly wrapped around the child's head at the occipital protuberance and the supraorbital prominence, thereby documenting the largest circumference. Care should be taken to ensure that the tape does not cut the skin. Make the reading to the nearest 0.5 cm or inch; remember to remeasure the head circumference at least once to check the accuracy of your measurement. TOP: Discipline: Physiology MSC: Organ System: Reproductive 18. Between 5 and 24 months of life, the infant's chest circumference is normally: a. about equal to the head circumference. b. greater than the head circumference by 2 inches. c. smaller than the head circumference by about 4 inches. d. at least 2 inches smaller than head circumference. e. none of the above; there is no relation between head and chest circumference during this period. ANS: A Between the ages of 5 months and 2 years, the infant's chest circumference should closely approximate the head circumference; the ratio should be monitored so that microcephaly can be identified, if present. TOP: Discipline: Physiology MSC: Organ System: Reproductive P a g e 50 | 413 NURS 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 R I GMSBC:.COrgaMn System: Reproductive U S N T O 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 P a g e 51 | 413 NURS 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 of the following is the most accurate reflection of an individual's food intake? a. 24-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assays e. Comparing the individual's intake with the MyPlate.gov website. ANS: B A food diary is recorded as it happens, making this method the most accurate reflection of an individual's food intake. 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, vitamNinUBR1S2,IanNdGvTitaBm.inCDO.M TOP: Discipline: Physiology MSC: Organ System: General 33. Monitoring a patient's waist-to-hip ratio provides data concerning: a. daily caloric requirements. b. lung capacity. c. stomach cancer risk. d. cardiovascular disease risk. e. developing an eating disorder. ANS: D Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular disease. 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 P a g e 52 | 413 NURS 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. e. Patients have amenorrheaN. URSINGTB.COM 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% P a g e 55 | 413 NURS 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. ANS: A NURS 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. increased terminal hair follicles to the tragus of men's ears. d. more prominent peripheral extremity hair production. e. women possibly developing less coarse facial hair. ANS: C The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus. TOP: Discipline: Physiology MSC: Organ System: Skin/Connective 8. Brittle nails are typical findings in: a. adolescents. b. infants. c. pregnant patients. P a g e 56 | 413 NURS 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 nNaiUls.RSINGTB.COM 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. using a Wood's lamp. e. using a pen light. ANS: C Daylight provides the best illumination source for determining color variations of the skin. 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. P a g e 57 | 413 NURS 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 historyNoUfRpSerIipNheGraTl Bva.scCuOlaMr disease ANS: D In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced; however, carotene pigmentation will not cause the sclera to turn yellow. TOP: Discipline: Pathophysiology 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. P a g e 60 | 413 NURS 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: PathophysiolNogUyRSINGMTSBC.: OCrOgaMn 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. P a g e 61 | 413 U S N T O NURS 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 R I G B.C M 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. P a g e 62 | 413 NURS ANS: B The question describes is the most common form of elder abuse—physical neglect. TOP: Discipline: Pathophysiology MSC: Organ System: Skin/Connective NURS P a g e 65 | 413 U S N NURS 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 adults’ lymph nodes diNminRishIin bGothBnu.mCberMand size and are replaced with more 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 P a g e 66 | 413 NURS 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. NURS 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. P a g e 67 | 413 NURS 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 R I GMSBC:.OCrgaMn System: Hematopoietic/Lymphoid U S N T O 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. P a g e 70 | 413 NURS 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 NURS P a g e 71 | 413 NURS Chapter 11: Head and Neck Ball: Seidel’s Guide to Physical Examination, 9th Edition 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 NURS 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. P a g e 72 | 413 NURS 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's apple. TOP: Discipline: Physiology NURSING M T SBC.: OCr O gaMn 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. P a g e 75 | 413 U S N NURS 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 thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data indicate: a. a congenital anomaly. b. a normal thyroid gland. c. a multinodular goiter. d. thyroiditis. e. a hypothyroid goiter. ANS: B The situation described is moNst lRikelIy a nGormBa.l CfindMing; 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. 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. P a g e 76 | 413 NURS 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. NURS 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 P a g e 77 | 413 NURS 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 associated with Graves diseaNseUoRr hSyIpeNrGthTyrBoi.diCsmO.MMyxedema 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 P a g e 80 | 413 NURS 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 NURS 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 P a g e 81 | 413 NURS b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates ANS: B Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders. 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 NURSINGMTSBC.: OCrOgaMn 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 by 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 adequacy of a patient's visual field is: a. the ability to discriminate primary colors. b. the ability to discriminate details. c. correspondence with the visual field of the examiner. P a g e 82 | 413 NURS 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. b. cognitive function. c. renal metabolism. d. bone marrow function. e. thyroid disease. ANS: A NURS 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. P a g e 85 | 413 NURS 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: PathophysiolNogUyRSINGMTSBC.: OCrOgaMn 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. P a g e 86 | 413 NURS 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. ANS: A NURS 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: P a g e 87 | 413 U S N NURS a. glaucoma. b. aging. c. presbyopia. d. papilledema. e. hypertension. ANS: B Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy. 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 liNneaRr paItternGaroBu.nCd thMe entire circumference of the iris are called: a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy. ANS: D Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation. 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 P a g e 90 | 413 NURS 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 NURS P a g e 91 | 413 NURS Chapter 13: Ears, Nose, and Throat Ball: Seidel’s Guide to Physical Examination, 9th Edition 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 theNossRicleIs. G B.C M e. produce a waxy lubricant. U S N T O 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 P a g e 92 | 413 U S N T O NURS 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 auditory canal, when compared with an adult's, is: a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved forward. d. short and curved downward. e. long, wide, and straight. ANS: B Compared with an adult's, the infant's auditory canal is shorter and has an upward curve, which is why pulling the pinna down straightens the canal. TOP: Discipline: Gross Anatomy MSC: Organ System: General N R I G B.C M 6. When examining an infant's middle ear, the practitioner should use one hand to stabilize the otoscope against the head while using the other hand to: a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. e. pull the auricle up. ANS: A You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal. 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 P a g e 95 | 413 U S N T O NURS 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 vibrating tuning fork on the midline vertex of the patient's head is a test for: a. air conduction of sound. b. bone versus air conduction. c. otitis externa. d. otitis media. e. lateralization of sound. ANS: E Placing the fork on the midline vertex of the patient's head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. TOP: Discipline: Physiology N R I G B.C M 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. P a g e 96 | 413 NURS 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 NURS 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. Fordyce spots. b. aphthous ulcers. c. Stensen ducts. d. leukoedema. e. 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. P a g e 97 | 413 NURS b. is sometimes seen after antibiotic therapy. c. usually indicates a vitamin deficiency. d. usually indicates anemia. e. is characteristic of a geographic tongue. ANS: B Recent antibiotic use can turn the tongue yellow-brown to black and hairy. 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 eNarUcRanSalI NG TB.C OM c. Redness and swelling of the mastoid process d. Small perforations of the tympanic membrane e. Increased mobility and clarity of the tympanic membrane ANS: A The newborn's tympanic membrane does not become conical for several months; therefore, the light reflex appears diffuse. 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: