SEIDEL'S GUIDE TO PHYSICAL EXAMINATION 9TH EDITION BALL TEST BANK UPDATED 2022/2024ALL CHA, Exams of Nursing

Download SEIDEL'S GUIDE TO PHYSICAL EXAMINATION 9TH EDITION BALL TEST BANK UPDATED 2022/2024ALL CHA and more Exams Nursing in PDF only on Docsity! Latest test bank 2022/2023 Chapter 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?‖ SELECTED ANSWER: B This question would limit the information in the patient's selected answerwer. The other choices allow the patient more discretion about the extent of an selected answerwer. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 2. Which action would best promote accurate trselected answerlations as well as confidentiality when the caregiver does not speak the patient's language? a. Ask a person unfamiliar with the patient to trselected answerlate. b. Have a friend of the patient trselected answerlate. c. Ask simple leading questions that the patient may understand. d. Use a neighbor as trselected answerlator. e. Involve the family with the trselected answerlation. Latest test bank 2022/2023 SELECT ED ANSWE R: A LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. U S N T O Latest test bank 2022/2023 e. desire for adult companionship. SELECTED ANSWER: D Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 12. When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should: a. order a neurology consult. b. sTOPIC all of his medications. c. continue to press the patient for appropriate selected answerwers. d. validate the concern with his family or caregivers. e. dismiss the finding as a normal age-related change. SELECTED ANSWER: D When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 13. To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional? a. All information should be obtained from family members. b. All information should be collected from past records while the patient is in another room. c. The patient should be invNolveRd oInlyGwheBn.yCou sMense that he or she may feel ignored. d. The patient should be fully involved to the limit of his or her ability. e. The patient should be present during information collection but should not be addressed directly. SELECTED ANSWER: D Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 14. When taking a history, you should: a. ask patients to give you any information they can recall about their health. b. start the interview with the patient's family history. c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. e. start the interview with the social history. SELECTED ANSWER: C Latest test bank 2022/2023 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. TOPIC: 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 trselected answermitted infection?‖ e. ―What sexually trselected answermitted diseases have you had in the past?‖ SELECTED ANSWER: 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. TOPIC: 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 patienNtUisRoSbvIioNuGslTy Bbe.inCgOvMictimized. e. used only when bruises are found on physical examination. SELECTED ANSWER: A The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients. TOPIC: 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. SELECTED ANSWER: C The CAGE questionnaire is a model for approaching a discussion of the use of alcohol. TOPIC: 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. U S N T Latest test bank 2022/2023 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. SELECTED ANSWER: E Interaction with children must be modified according to age and in a manner that promotes trust. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: Behavioral Science MSC: Organ System: General Latest test bank 2022/2023 Asking, if you are not sure, is far better than making a damaging mistake. You would not be doing your job as a professional if you deferred the examination without a reason. It is not necessary to refer a skill you are capable of performing. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 4. Which statement is true regarding impoverished people? a. In the United States, socioeconomic status does not influence the delivery of health care. b. The morbidity and mortality rates of impoverished people are greater than those of the middle class. c. The morbidity and mortality rates of impoverished people are less than those of the middle class. d. No reliable statistics exist regarding the relationship of poverty to morbidity and mortality. e. The morbidity and mortality rates of impoverished people are similar to those of the middle class. SELECTED ANSWER: B Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 5. In terms of cultural communication differences, Americselected answer are more likely to than other groups of patients. a. emphasize attitudes and feelings b. maintain eye contact LATEST TEST BANK c. come quickly to the point d. use silence comfortably e. speak more softly than other cultures SELECTED ANSWER: C In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 6. Which question has the most potential for exploring a patient's cultural beliefs related to a health problem? a. ―How often do you have a medical examination?‖ b. ―What are your age, race, and educational level?‖ c. ―What types of symptoms have you been having?‖ d. ―Why do you think you are having these symptoms?‖ e. ―Do you take herbal remedies?‖ SELECTED ANSWER: D This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. TOPIC: Discipline: Behavioral Science MSC: Organ System: General Latest test bank 2022/2023 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. SELECTED ANSWER: 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. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 8. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americselected answer, Asiselected answer, 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. SELECTED ANSWER: 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 Americselected answer, Asiselected answer, and Arabs embrace a more ―holistic‖ approach. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: E Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well. Latest test bank 2022/2023 TOPIC: 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. SELECTED ANSWER: D The purpose of understanding the patient's culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. TOPIC: 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. SELECTED ANSWER: 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 TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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 U S N Latest test bank 2022/2023 b. Dorsal recumbent c. Left lateral recumbent d. Right Sims e. Prone SELECTED ANSWER: C The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 5. The use of secondary, tangential lighting is most helpful in the detection of: a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. e. variations in texture and mobility. SELECTED ANSWER: D Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 6. You are conducting a head to toe examination as part of a patient's preventive health assessment. The room has adequate lighting, and you have access to both sides of the examining table. What positiNon sRhouIld yGou Bas.suCmeMwhile conducting this examination? a. Behind the patient b. To the left side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient e. Standing in front of the patient SELECTED ANSWER: D Although conventionally taught to approach an examination from the patient's right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 7. Which part of the examiner's hand is best for palpating vibration? a. Dorsal surface b. The thumb c. Fingertips d. Ulnar surface and base of the fingers e. Finger pads SELECTED ANSWER: D The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus. Latest test bank 2022/2023 TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: C Whereas a normal lung produces resonance percussion tones, an empty stomach is expected to produce tympany. Dull percuNssUioRnStoInNesGaTreBh.eaCrdOoMver the liver. TOPIC: 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. SELECTED ANSWER: C Dull tones are expected over more dense areas such as the liver. TOPIC: 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. SELECTED ANSWER: A Latest test bank 2022/2023 The dominant hand's middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. TOPIC: 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. SELECTED ANSWER: C By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds. TOPIC: 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 SELECTED ANSWER: A Inspection is always used as the first technique in all physical examinations, including the abdomen. LATEST TEST BANK TOPIC: 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. SELECTED ANSWER: B Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. TOPIC: 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. Latest test bank 2022/2023 TOPIC: Discipline: Pathophysiology MSC: Organ System: General 23. The pneumatic attachment for the otoscope is used to evaluate: a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. e. tympanic membrane temperature. SELECTED ANSWER: D The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 24. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: a. vibratory sensations. b. hearing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level. e. peripheral motor nerve damage. SELECTED ANSWER: C Normal speech has a range of 300 to 3000 Hz; therefore, a 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech. TOPIC: Discipline: PathophysiolNogyR I GMSBC:.OCrgaMn System: General U S N T O 25. A variant of the percussion hammer is a neurologic hammer, which is equipped with which of the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell e. Trselected answerilluminator SELECTED ANSWER: A A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 26. Trselected answerillumination functions on the principle that: a. infrared radiation is easily detected. b. black light causes certain substances to fluoresce. c. converging and diverging light brings structures into focus. d. tangential light casts shadows that illuminate contours. e. air, fluid, and tissue trselected answermit light differentially. SELECTED ANSWER: E Latest test bank 2022/2023 Trselected answerillumination 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 spectrumwith a narrow beam. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. LATEST TEST BANK e. Raise her legs above her heart. SELECTED ANSWER: 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. TOPIC: Discipline: Pathophysiology MSC: Organ System: General Latest test bank 2022/2023 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. SELECTED ANSWER: 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. TOPIC: 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.‖ SELECT ED ANSWE R: A LATEST TEST BANK 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 4. Medical decision making requires a balance between: a. speculation and feelings. b. opinions and beliefs. Latest test bank 2022/2023 SELECTED ANSWER: E The definition of beneficence is to do good, not being paternalistic, and the need to avoid harm refers to nonmaleficence. Utilitarianism is the appropriate use of resources for the greater good of the larger community. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 12. The term denoting the caregiver's need to do no harm to the patient is: a. autonomy. b. deontologic imperative. c. nonmaleficence. d. utilitarianism. e. beneficence. SELECTED ANSWER: C The definition of nonmaleficence is to do no harm. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 13. Which of the following is initially appropriate in the management of a patient's diagnosed problem? a. Inform the patient of the treatment plan. b. Give the patient detailed written instructions regarding the treatment plan. c. Inform the patient that the plan has been tailored to his needs. d. Inform the patient of treatment options and possible results. e. Lead the patient to an understanding that you know the best treatment option. SELECT ED ANSWE R: D LATEST TEST BANK An initial approach to a patient's problem should allow for the greatest patient autonomy and should promote patient participation. The well-informed patient is better able to exercise autonomy. Only informing the patient of treatment options and possible results does this. TOPIC: Discipline: Behavioral Science MSC: Organ System: General Latest test bank 2022/2023 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. SELECTED ANSWER: 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. TOPIC: 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. SELECT ED ANSWE R: C LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. Latest test bank 2022/2023 e. indicate consistency of lymph nodes. SELECTED ANSWER: 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: C LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: B After the examiner has a list of problems constructed, an assessment is made for each unique problem. TOPIC: Discipline: Behavioral Science MSC: Organ System: General Latest test bank 2022/2023 For a newborn, the focus of recorded information is the details of the mother's pregnancy, the gestational development, and events occurring since birth. These data are recorded in the present problem section of the history. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 16. Data relevant to the social history of older adults include information on: a. family support systems. b. extra time to assume positions. c. over-the-counter medication intake. d. date of last cancer screening. e. previous healthcare visits. SELECTED ANSWER: A The social history of older adults includes community and family support systems. Healthcare visits, medications, cancer screenings, and extra time to assume positions for the physical examination are not part of the social history. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 17. A SOAP note is used in which type of recording system? a. Preventive care b. Pedigree c. Systems review d. Traditional treatment e. Problem oriented SELECT ED ANSWE R: E LATEST TEST BANK A SOAP note, which includes subjective problem data, objective problem data, assessment, and plan, is a type of recording system that has a problem-oriented style. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 18. The examiner's evaluation of a patient's mental status belongs in the: a. history of present illness. b. review of systems. c. physical examination. d. patient education. e. problem list. SELECTED ANSWER: C Mental status assessment, including cognitive and emotional stability and speech and language, is part of the physical examination. Anything subjective is part of the review of systems and those findings that are objective are part of the provider's assessment. TOPIC: Discipline: Behavioral Science MSC: Organ System: General 19. When recording physical findings, which data are recorded first for all systems? a. Review of systems b. Percussion c. Palpation d. Auscultation Latest test bank 2022/2023 e. Inspection SELECTED ANSWER: E Physical assessment for all systems begins with inspection. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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 SELECTED ANSWER: B LATEST TEST BANK 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. TOPIC: Discipline: Behavioral Science MSC: Organ System: General Latest test bank 2022/2023 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. SELECTED ANSWER: B Body temperature is regulated by the hypothalamus. TOPIC: 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 SELECTED ANSWER: D Body cooling occurs by vasodilation, which increases heat loss through the skin and evaporation of perspiration. LATEST TEST BANK TOPIC: 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 SELECTED ANSWER: 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). TOPIC: Discipline: Pathophysiology MSC: Organ System: General 4. Nociceptors trselected answermit pain impulses from the periphery along A-delta and C- polymodal fibersto the: a. posterior horn of the spinal cord. b. hypothalamus. c. cerebellum. d. dorsal horn of the spinal cord. Latest test bank 2022/2023 12. The heart rate of a pregnant woman may increase to a level at term that is _ higher than normal. a. 5% to 10% b. 10% to 30% c. 40% to 60% d. 60% to 80% e. 80% to 100% SELECTED ANSWER: B The heart rate of a pregnant woman gradually increases throughout pregnancy until it is 10% to 30% higher at term. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 13. Hypertension in a pregnant woman (blood pressure reading greater than or equal to 160 mm Hg systolic or 110 mm Hg diastolic) is one sign of: a. a normal pregnancy. b. a nulliparous woman. c. preeclampsia. d. a multiparous woman. e. Braxton Hicks contractions. SELECTED ANSWER: C A gradual increase in blood pressure is common from the second to the third trimester. However, hypertension in this range may be a sign of preeclampsia. Braxton Hicks contractions are sporadic uterine contractions that start at around 6 weeks of pregnancy and are not associated with gestational hypertension or preeclampsia. LATEST TEST BANK TOPIC: Discipline: Pathophysiology MSC: Organ System: General 14. Blood pressure may increase during the process of aging caused by: a. increasing vagal tone. b. decreasing cardiac output. c. diminished tolerance to pain. d. increasing stiffness of the blood vessels. e. decreasing vascular resistance. SELECTED ANSWER: D During the process of aging the systolic blood pressure often increases because of increasing stiffness of the blood vessels and increased vascular resistance. Increasing vagal tone may decrease the pulse rate. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 15. The difference in blood pressure readings between the right and left arms is considered normal up to mm Hg. a. 5 b. 10 c. 20 d. 25 e. 30 Latest test bank 2022/2023 SELECTED ANSWER: 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: C LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: Pathophysiology MSC: Organ System: Cardiovascular Latest test bank 2022/2023 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% SELECTED ANSWER: 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). TOPIC: Discipline: Pathophysiology MSC: Organ System: Cardiovascular LATEST TEST BANK Latest test bank 2022/2023 b. delirium. c. stupor. d. coma. e. confusion. SELECTED ANSWER: B Delirium is a state of impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset. Stupor describes arousals for short periods of time after a stimulus for arousal (e.g., visual, verbal, or painful). Lethargy relates to sleepiness with ease of arousal; coma is nonarousal and nonawareness. Confusion relates to inappropriate responses to questions with decreased attention span and memory. TOPIC: Discipline: Neuroscience MSC: Organ System: Nervous 9. When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing which of the following? a. Level of consciousness b. Abstract reasoning c. Emotional stability d. Memory e. Impaired judgment SELECTED ANSWER: B Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the patient’s ability to reason abstractly. This intelligence test does not assess level of consciousness, emotional health, judgment, or memory. TOPIC: Discipline: Behavioral SNciUenRceSINGMTSBC.: OCrOgaMn System: Nervous 10. Impairment of arithmetic skills is often caused by: a. impaired execution of motor skills. b. impaired judgment. c. peripheral neuropathies. d. depression. e. perceptual distortions. SELECTED ANSWER: D The patient with depression or diffuse brain disease can display difficulty with simple arithmetic calculations. This is not commonly seen with motor skill impairments, judgment impairments, or perceptual distortions and hallucinations. Peripheral neuropathies are best assessed by evaluating motor skills. TOPIC: Discipline: Behavioral Science MSC: Organ System: Nervous 11. Peripheral neuropathy is most likely to be manifested by: a. impaired memory. b. impaired abstract reasoning. c. impaired writing ability. d. hallucinations. e. difficulties with analogies. SELECTED ANSWER: C Latest test bank 2022/2023 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: Behavioral Science MSC: Organ System: Nervous 13. Appropriateness of logic, sequence, cohesion, and relevance to TOPICics are markers for theassessment of: a. mood and feelings. b. attention span. c. thought process and content. d. abstract reasoning. LATEST TEST BANK e. speech and language skills. SELECTED ANSWER: 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 TOPICics discussed. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: Neuroscience MSC: Organ System: Nervous Latest test bank 2022/2023 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 SELECTED ANSWER: 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: B Latest test bank 2022/2023 e. five times the SELECTED ANSWER: D Lymphatic tissues are small compared to the total body size, but they are almost fully developed at birth. They grow fast and are about twice the adult size by 10 to 12 years of age. TOPIC: Discipline: Physiology MSC: Organ System: HemaTOPICoietic/Lymphoid 5. Which organ(s) complete(s) physical development more quickly than any other body part? a. Brain b. Kidneys c. Heart d. Lungs e. Lymphoid tissue SELECTED ANSWER: A Along with the skull, eyes, and ears, the brain completes development more quickly than any other part of the body; its most rapid growth occurs from conception to age 2 years. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 6. During adolescence, the head size normally increases as a result of: a. sinus development. b. brain mass increase. c. evolution of lymphatic tissue. d. hypertrophy of glial cells. e. hypertrophy of myelin. SELECT ED ANSWE R: A LATEST TEST BANK As the facial sinuses grow, the head size enlarges its surface area to accommodate this growth. TOPIC: Discipline: Physiology MSC: Organ System: General 7. Fifty percent of an individual's ideal weight is gained during: a. pregnancy. b. preschool years. c. adolescence. d. early adulthood. e. older adulthood. SELECTED ANSWER: C During adolescence, the trunk and legs grow the most, causing orgselected answer and the skeletal mass todouble in size. During pregnancy, weight gain is accounted for by the growing fetus and pregnancy orgselected answer (placenta and uterus). In the preschool years, weight is gained at a steady rate, with fat tissue increasing slowly until about 7 years of age. In early adulthood, there is a reduction in size and weight. A decrease in weight for height and body mass index has been found with increasing age between 70 and 89 years of age. TOPIC: Discipline: Physiology MSC: Organ System: General 8. Sexual maturation begins earlier in girls with a higher: a. upper-to-lower segment ratio. Latest test bank 2022/2023 b. arm span. c. head circumference. d. gestational age. e. body mass index (BMI). SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: C The legs grow the fastest during childhood, the trunk grows fastest in infancy, and the skeletal muscles and orgselected answer grow fastest in early adulthood. TOPIC: 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. SELECTED ANSWER: C LATEST TEST BANK During puberty, sex steroids stimulate secretion of growth hormone, causing the orgselected answer andskeletal mass to double in size. TOPIC: 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. SELECTED ANSWER: 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. U S N T Latest test bank 2022/2023 TOPIC: 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 SELECTED ANSWER: 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). TOPIC: 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. SELECTED ANSWER: 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 TOPIC: 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 SELECTED ANSWER: C Infant length generally increases by 50% in the first year of life. TOPIC: 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 SELECTED ANSWER: C Latest test bank 2022/2023 TOPIC: Discipline: Pathophysiology MSC: Organ System: Musculoskeletal 23. Which of the following statements regarding female pubertal changes is true? a. Most adolescent girls develop breasts before pubic hair. b. Peak height velocity should occur after menarche. c. Breast asymmetry is an abnormal finding. d. Menarche should occur by Tanner breast stage B. e. Sexual maturation begins later in taller and heavier girls. SELECTED ANSWER: A In two-thirds of girls, breasts begin to develop before pubic hair. Peak height velocity actually occurs about 1 year before menarche, breast asymmetry is common, and menarche occurs after Tanner breast stage B. Sexual maturation begins earlier in taller and heavier girls. TOPIC: Discipline: Physiology MSC: Organ System: Reproductive 24. At what age does peak height growth velocity occur in boys? a. 6 years b. 10 years c. 12 years d. years e. years SELECTED ANSWER: D Peak height velocity occurs at an average age of years. TOPIC: Discipline: Physiology NURSINGMTSBC.: COrOga M n System: Musculoskeletal 25. What is the youngest age at which pubic hair growth in a boy may be considered normal? a. 7 years b. 8 years c. 9 years d. 10 years e. 11 years SELECTED ANSWER: C In boys, sexual development before 9 years of age is precocious puberty and is considered an abnormal finding. TOPIC: Discipline: Physiology MSC: Organ System: Endocrine 26. Which Tanner stage is marked by the most significant growth in penis length? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5 SELECTED ANSWER: C Tanner stage 3 is marked by enlargement of the penis, especially in length. Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C TOPIC: 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 SELECTED ANSWER: D Tanner stage 4 depicts the stage in which the areola forms a second mound above the breast. TOPIC: 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 SELECTED ANSWER: D Women of normal BMI should expect to gain between 25 and 35 pounds during pregnancy. TOPIC: 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. SELECTED ANSWER: B These presenting features are all prominent characteristics of acromegaly; teeth separation and malocclusion can result from the maxillary widening. TOPIC: 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. SELEC Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C These are all commonly associated characteristics of Cushing syndrome, with the buffalo hump as a distinguishing feature. TOPIC: 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. SELECTED ANSWER: B A food diary is recorded as it happens, making this method the most accurate reflection of an individual's food intake. TOPIC: 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 SELECTED ANSWER: B The nutrients that may be deficient in a vegetarian diet if not carefully planned include proteins, calcium, iron, vitamNinUBR1S2,IanNdGvTitaBm.inCDO.M TOPIC: 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. SELECTED ANSWER: D Waist-to-hip ratios may aid in predicting relative disease risk in terms of cardiovascular disease. TOPIC: Discipline: Physiology MSC: Organ System: General 34. Which of the following is a macronutrient? a. Iron b. Thiamin c. Calcium d. Fat e. Alcohol SELECTED ANSWER: D Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C Chapter 09: Skin, Hair, and Nails Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. The skin repairs epidermal wounds by: a. exaggerating cell replacement. b. excreting lactic acid. c. producing vitamins. d. providing a mechanical barrier. e. increasing the vascularity of the epidermis. SELECTED ANSWER: A The skin's tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition. TOPIC: Discipline: Physiology MSC: Organ System: Skin/Connective 2. The adipose tissue in the hypodermis serves to: a. provide sensory input. b. generate heat and insulate. c. create tensile strength. d. restrict water loss. e. secrete collagen. SELECT ED ANSWE R: B LATEST TEST BANK The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories. TOPIC: Discipline: Physiology MSC: Organ System: Skin/Connective 3. The secretory activity of the sebaceous glands is stimulated by: a. body heat. b. ambient temperature. c. sex hormones. d. dietary protein. e. emotional stimuli. SELECTED ANSWER: C The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a lipid-rich substance that keeps the skin moist. TOPIC: Discipline: Physiology MSC: Organ System: Skin/Connective 4. Which structure is the site of new nail growth? a. Cuticle b. Paronychium c. Eponychium d. Nail bed Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C e. Matrix SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: A LATEST TEST BANK During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne. TOPIC: 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. SELECTED ANSWER: C The trselected answerition from vellus to terminal hair pattern occurs in older men at the nares and thetragus. TOPIC: Discipline: Physiology MSC: Organ System: Skin/Connective 8. Brittle nails are typical findings in: a. adolescents. b. infants. c. pregnant patients. Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C d. older adults. e. children. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: A Decreased circulation to the nails of older adults causes nail growth retardation. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: C Daylight provides the best illumination source for determining color variations of the skin. TOPIC: 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. U S N Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C 20. Trselected answerient mottling of the patient's skin in a cool room is a common finding in: a. menopausal women. b. newborn infants. c. pregnant patients. d. sedentary adults. e. older adults. SELECTED ANSWER: B Cutis marmorata, a mottled appearance, is part of a newborn's response to changes in temperature. TOPIC: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 21. A single trselected answerverse crease seen on the palm of a small child may imply: a. Down syndrome. b. Turner syndrome. c. systemic sclerosis. d. profound dehydration. e. neurofibromatosis. SELECTED ANSWER: A A single trselected answerverse crease is seen on the palm of children with Down syndrome. TOPIC: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 22. Cafe au lait patches are numbered with each assessment of infants and young children because: a. their numbers are expecteNd toRincIreaGse eBac.hCyeaMr. b. coalescent lesions are a more serious finding. c. the presence of more than six patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. e. a higher number correlates with the development of erythema toxicum. SELECTED ANSWER: C The presence of more than six patches with diameters of more than 5 mm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches are usually considered harmless. TOPIC: Discipline: Pathophysiology MSC: Organ System: Skin/Connective 23. Cherry angiomas are a common finding in: a. adults older than 30 years. b. newborns. c. pregnant patients. d. sunbathers. e. adolescents. SELECTED ANSWER: A Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age. TOPIC: Discipline: Pathophysiology MSC: Organ System: Skin/Connective Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C 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. SELECTED ANSWER: D Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: PathophysiolNogUyRSINGMTSBC.: COrOgaMn 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. SELECTED ANSWER: A Unlike other skin conditions, silvery papules and plaques characterize psoriasis. TOPIC: 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. SELECTED ANSWER: 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. U S N T Seidel's Guide to Physical Examination 9th Edition Ball Test NURSINGTB.C TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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 TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 5. Lymph flows faster in response to: a. massage. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. e. decreased capillary pressure. SELECTED ANSWER: A Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 6. An organ that is essential to the development of protective immune function in infants but has little or no demonstrated function in adults is the: a. spleen. b. appendix. c. thymus. d. pancreas. e. liver. SELECTED ANSWER: C In adults, the thymus atrophiNesU, aRnSd IinNoGldTerBa.duCltOs,Mit is replaced by fat and connective tissue. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 7. When enlarged, which lymph nodes are most likely to be a sign of malignancy? a. Occipital b. Anterior cervical c. Posterior cervical d. Femoral e. Supraclavicular SELECTED ANSWER: E Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 8. Lymphoid tissue normally regresses to adult size by: a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. e. the early 20s. SELECTED ANSWER: D Seidel's Guide to Physical Examination 9th Edition Ball Test U S The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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. SELECTED ANSWER: B In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 10. As adults age, their ability to resist infection decreases because of lymphatic nodes becoming more: a. hemaTOPICoietic. b. mucoid. c. porous. d. profuse. e. fibrotic. SELECTED ANSWER: E Older adults’ lymph nodes diNminRishIin bGothBnu.mCberMand size and are replaced with more fibrotic and fatty tissues. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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 SELECTED ANSWER: 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 trselected answermission of HIV. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 12. Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender e. Matted Seidel's Guide to Physical Examination 9th Edition Ball Test SELECTED ANSWER: D Tenderness is almost always indicative of inflammation. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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 SELECTED ANSWER: C The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 14. Which nodes are also called Virchow nodes? a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular e. Preauricular SELECTED ANSWER: D The supraclavicular nodes are also referred to as Virchow nodes. LATEST TEST BANK TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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. SELECTED ANSWER: 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. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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. SELECTED ANSWER: D Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable. Seidel's Guide to Physical Examination 9th Edition Ball Test U S N T 24. To find the infection site associated with acute lymphangitis, the examiner should look to the inflammation. a. proximal b. distal c. contralateral d. anterior e. posterior SELECTED ANSWER: B The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 25. The most common causes of acute suppurative lymphadenitis are: a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex type 1 and type 2. d. streptococcal and staphylococcal organisms. e. mumps. SELECTED ANSWER: D Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid N R I G B.C M 26. Which disorder is characterized by a single node that is chronically enlarged and nontender in a patient with no other symptoms? a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis e. Herpes simplex SELECTED ANSWER: D Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid 27. Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include: a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. e. discrete labial and gingival ulcers and high-grade fever. SELECTED ANSWER: A Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash. Seidel's Guide to Physical Examination 9th Edition Ball Test SELECTED ANSWER: C Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema. TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/Lymphoid LATEST TEST BANK TOPIC: Discipline: Immunology MSC: Organ System: HemaTOPICoietic/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. Seidel's Guide to Physical Examination 9th Edition Ball Test 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 SELECTED ANSWER: 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. TOPIC: 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 SELECTE D ANSWER: B LATEST TEST BANK 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. TOPIC: 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 SELECTED ANSWER: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test U S N 11. Coarse, dry, and brittle hair is associated with which metabolic disorder? a. Hypothyroidism b. Diabetes mellitus c. Addison disease d. Cushing syndrome e. Fetal alcohol syndrome SELECTED ANSWER: A Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes. TOPIC: Discipline: Pathophysiology MSC: Organ System: Endocrine 12. Which is the best way to position a patient's neck for palpation of the thyroid? a. Flexed away from the side being examined b. Flexed directly forward c. Flexed toward the side being examined d. Hyperextended directly backward e. Rotated away from the side being examined SELECTED ANSWER: C The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward and laterally toward the side being examined. TOPIC: Discipline: Gross Anatomy MSC: Organ System: Musculoskeletal 13. A stethoscope is used in a heNad aRnd nIeckGexBam.iCnatiMon to assess: a. intracranial fluid. b. pulsating fontanels. c. skull bone development. d. thyroid vascular sounds. e. parotid glands. SELECTED ANSWER: D Although the skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits. TOPIC: Discipline: Gross Anatomy MSC: Organ System: General 14. Tracheal tug suggests the presence of a(n): a. enlarged thyroid. b. swallowing disorder. c. aortic aneurysm. d. thoracic carcinoma. e. hyperparathyroidism. SELECTED ANSWER: C When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensation in sync with the pulse of the patient. An enlarged thyroid, swallowing disorder, hyperparathyroidism, or thoracic carcinoma would not produce a tracheal tug. Seidel's Guide to Physical Examination 9th Edition Ball Test U S TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. LATEST TEST BANK c. increased intracranial pressure. d. fever response to a viral infection. e. cephalhematoma. SELECTED ANSWER: C A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel feels slightly depressed with mild pulsations. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: Discipline: Neuroscience MSC: Organ System: Nervous Seidel's Guide to Physical Examination 9th Edition Ball Test Chapter 12: Eyes Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Contraction or relaxation of the ciliary body: a. allows voluntary blinking. b. changes lens thickness. c. regulates peripheral vision. d. sends light impulses to the brain. e. regulates tear production. SELECTED ANSWER: B The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 2. Term infants have a visual acuity of about: a. 20/20. b. 20/100. c. 20/200. d. 20/300. e. 20/400. SELECTED ANSWER: E LATEST TEST BANK Term infants are hyperopic, with a visual acuity of less than 20/400. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 3. At what age does an infant usually develop the ability to distinguish color? a. At birth b. 2 months c. 6 months d. 12 months e. 16 months SELECTED ANSWER: C By 6 months of age, vision has developed so that colors can be differentiated. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 4. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood c. Infancy d. Pregnancy e. Older adults Seidel's Guide to Physical Examination 9th Edition Ball Test SELECTED ANSWER: 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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. SELECT ED ANSWE R: A LATEST TEST BANK 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: 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 Seidel's Guide to Physical Examination 9th Edition Ball Test b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates SELECTED ANSWER: 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. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 9. Mr. C's visual acuity is 20/50. This meselected answer 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. SELECTED ANSWER: D Visual acuity is measured as a fraction in which the TOPIC number is the distance that the patientis 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. TOPIC: Discipline: Physiology NURSINGMTSBC.: COrOgaMn System: Nervous 10. Peripheral vision can be estimated by meselected answer of which test? a. Confrontation b. Pupillary reaction c. Accommodation d. Snellen E chart e. Swinging flashlight SELECTED ANSWER: 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. TOPIC: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 19. Mr. B was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been: a. in a coma. b. taking sympathomimetic drugs (e.g., cocaine). c. taking opioid drugs (e.g., morphine). d. treated for head trauma. e. atropine overdosed. SELECTED ANSWER: C Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or drops for glaucoma. Pupils are usually dilated greater than 6 mm in a coma and with sympathomimetic drugs, atropine, and head trauma. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 20. You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for: a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. e. corneal arcus senilis. SELECTED ANSWER: B LATEST TEST BANK Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 21. Mydriasis accompanies: a. coma. b. diabetes. c. hyperopia. d. astigmatism. e. morphine administration. SELECTED ANSWER: A Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. Opiates cause miosis. Seidel's Guide to Physical Examination 9th Edition Ball Test TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test e. optic disc. SELECTED ANSWER: D The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: A LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 29. Drusen bodies are most commonly a consequence of: Seidel's Guide to Physical Examination 9th Edition Ball Test 36. Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in: a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa. SELECTED ANSWER: B Dot hemorrhages or tiny aneurysms are characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, lupus, glaucoma, or retinitis pigmentosa. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 37. Changes seen in proliferative diabetic retinopathy are the result of: a. anoxic stimulation. b. macular damage. c. papilledema. d. minute hemorrhages. e. chorioretinal scarring. SELECTED ANSWER: A New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply because of failing capillaries causes new vessel growth. Macular damage, papilledema, chorioretinal inflammation, and resultant scarring do not involve new inadequate vessel growth. LATEST TEST BANK TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 38. Bone spicule pigmentation is a hallmark of: a. chorioretinal pigmentosa. b. cytomegalovirus infection. c. lipemia retinalis. d. retinitis pigmentosa. e. choroidal nevus. SELECTED ANSWER: D Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous 39. Retinal hemorrhages in an infant require investigation for: a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor. d. child abuse. e. strabismus. SELECTED ANSWER: D Seidel's Guide to Physical Examination 9th Edition Ball Test LATEST TEST BANK Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages. TOPIC: Discipline: Pathophysiology MSC: Organ System: Nervous Seidel's Guide to Physical Examination 9th Edition Ball Test 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. SELECTED ANSWER: 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. TOPIC: 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. trselected answermit vibrations to G B.C M theNossRicleIs. e. produce a waxy lubricant. SELECTED ANSWER: C S N T O 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. TOPIC: 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 SELECTED ANSWER: 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. TOPIC: Discipline: Physiology MSC: Organ System: General U Seidel's Guide to Physical Examination 9th Edition Ball Test b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz e. Greater than 2000 Hz SELECTED ANSWER: C Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. TOPIC: Discipline: Physiology MSC: Organ System: Nervous 12. You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. make sure the speculum is sealed form outside air. c. squeeze the bulb with more force. d. insert the speculum to depth of 2 cm. e. use a smaller plastic speculum. SELECTED ANSWER: B When using the pneumatic attachment, to see tympanic movement, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb. TOPIC: Discipline: Physiology MSC: Organ System: General 13. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorder. b. skeletal anomaly. c. renal disorder. d. Ménière disease. e. heart defect. SELECTED ANSWER: C LATEST TEST BANK A low-set position or unusual angle may indicate a genetic syndrome or be a clue to look for renal anomalies as the ears and kidneys grow at the same time during pregnancy. TOPIC: Discipline: Pathophysiology MSC: Organ System: General 14. When conducting an adult otoscopic examination, you should: a. position the patient's head leaning toward you. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. e. pull the auricle down and forward. SELECTED ANSWER: C Select the largest speculum that will comfortably fit in the patient's ear. The handle should be held between the thumb and the index finger, supported on the middle finger. The patient's head should be positioned toward the opposite shoulder. To straighten the external auditory in an adult, pull the auricle up and back. There is no reason for the patient to keep her or his eyes shut. Seidel's Guide to Physical Examination 9th Edition Ball Test U S N T TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: 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. TOPIC: 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. TOPIC of the head. b. mastoid bone. c. forehead. d. preauricular area. e. occiput. SELECTED ANSWER: 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 TOPIC of the patient's head for theWeber test, a test that helps assess unilateral hearing loss. TOPIC: 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. Seidel's Guide to Physical Examination 9th Edition Ball Test SELECTED ANSWER: 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. TOPIC: 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. SELECTED ANSWER: B An allergic finding includes bluish gray or pale pink nasal turbinates that are swollen and boggy and a trselected answerverse crease at the junction between the cartilage and the bone of the nose. TOPIC: 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. SELECT ED ANSWE R: A LATEST TEST BANK 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. TOPIC: 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. SELECTED ANSWER: B Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa. TOPIC: 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.