NURS 6512 Health Assessment Study Exam Preparations Materials, Exams of Nursing

Download NURS 6512 Health Assessment Study Exam Preparations Materials and more Exams Nursing in PDF only on Docsity! NURS 6512 Health Assessment Study Exam Preparations Materials With Latest Updates Already GRADED A+ A 19-year-old woman has painful ulcers on the labial mucosa and buccal mucosa of 4 days duration. She has had similar ulcers on previous occasions, and each time the lesions healed in approximately 7 days. The best diagnosis is aphthous ulcers A 67-year-old woman has a chronic sore mouth of 2 years duration. The lesions consist of multiple persistent ulcers adjacent to white rough thickened areas which do not rub off and are arranged in a striated pattern. The lesions are bilateral and involve the buccal mucosa, lateral borders of the tongue, and gingiva. Of the following, the best diagnosis is lichen planus A patient has multiple, asymptomatic, irregular, flat patches on the dorsum of the tongue. Each patch has a red center and an irregular white periphery. The patient reports that the lesions come and go. The best diagnosis is geographic tongue (erythema migrans) A 16-year-old woman has a compressible, nontender, 5x5 mm soft tissue enlargement of the lower labial mucosa. The lesion has a blue mucosal surface which does not blanch upon palpation. The patient states that she has been aware of the lesion for 2 months and that it has increased and decreased in size during this time. Of the following, the best diagnosis is mucocele A 13-year-old female patient has mild fever, lymphadenopathy and vesicles and ulcers of the soft palate and tonsillar pillars bilaterally, of 5 days duration. No other oral lesions are present. The best diagnosis is herpangina A patient has a white, nontender, 5 x 6 mm, soft tissue enlargement on the right soft palate of at least 2 years duration. The surface is rough and resembles a wart. The lesion is pedunculated. The best diagnosis is papilloma Upgrade to remove ads A 44-year-old man has rough, white, nonpainful lesions which do not rub off located bilaterally on the buccal mucosa, floor of the mouth, and hard and soft palates. He states that he has been aware of the lesions since childhood. Of the following, the best diagnosis is white sponge nevus A 25-year-old woman has a 5x6 mm, nontender, compressible soft tissue enlargement located on the interdental papilla between teeth #10 and #11. The lesion is erythematous and bleeds easily. She states that she has been aware of the lesion for approximately 3 days. The patient is in her second trimester of pregnancy. Of the following, the best diagnosis is pyogenic granuloma Which white surface lesion rubs off? Burn Which of the following lesions is asymptomatic and smooth to palpation? Scarring Which pigmented surface lesion is consistently flat and not thickened? Oral melanotic macule When questioning the patient regarding his or her sexual history, which question should be asked initially? "Do you have any worries or concerns regarding your sex life?" A guideline for history taking is for caregivers to make notes sparingly so that patients can be observed during the history taking. Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the personal and social history. Direct questioning about intimate partner violence in the home should be a routine component of history taking with female patients. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the CAGE questionnaire. A tool used to screen adolescents for alcoholism is the CRAFFT. 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 leave the child sitting in the father's lap while you talk to the father. 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? Propensity for risk taking Pain is difficult to assess in older adults because sharp pain may be felt as a dull ache. A survey of mobility and activities of daily living (ADLs) is part of a(n) functional assessment. Constitutional symptoms in the ROS refer to: fever, chills, fatigue, and malaise. J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history. problem or focused Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more and doesn't hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle "Have you made plans to harm yourself?" Which of the following is considered an IADL but not an ADL? Paying bills A pedigree diagram is drafted for the purpose of obtaining genetic and familial health problems. The primary objective of the initial encounter is to: establish the tone of a successful partnership. If language is a barrier, the interpreter should be: a professional interpreter Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more and does not hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle: "Have you made plans to harm yourself?" Ms. Yale is a 52-year-old patient who presents to the office for evaluation. During the interview, you say "Tell me what you do when you have knee pain." The health care provider is asking information about: aggravating and relieving factors of the complaint. Which question would be considered a "leading question?" "You don't get headaches often, do you?" To prevent personal appearance from becoming an obstacle in patient care, the health care professional should: avoid extremes in dress. Which action would best promote accurate translation and confidentiality when the caregiver does not speak the patient's language? Ask a person unfamiliar with the patient to translate. When are open-ended questions generally most useful? During the initial part of the interview. Behaviors that diffuse anxiety during the interview include: providing forthright answers to questions. Periods of silence during the interview can serve important purposes, such providing time for reflection. Which technique is most likely to result in the patient's understanding of questions? Use the patient's own terms if possible. Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, "I've had this cough for 3 days, and it's getting worse." You reply, "Tell me more about your cough." Mr. Franklin states, "I wish I could tell you more. That's why I'm here. You tell me what's wrong!" Which caregiver response would be most appropriate for enhancing communication? "After 3 days, you're tired of coughing. Have you had a fever?" Mr. Miller is a 46-year-old patient who becomes restless during the history and says, "I don't have time for all of this conversation. I've got to get back to work." Your most appropriate response would be to: remember (acknowledge) his anger and proceed with the history and examination. When you are questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate? "What amount and what kind of alcohol do you drink in a week?" Ms. T is crying and states that her mother couldn't possibly have a tumor. "No one else in the family has ever had cancer!" exclaims the daughter. The most appropriate response to Ms. T would be: "Why do you think that your mother's tumor is cancerous?" After you ask a patient about her family history, she says, "Tell me about your family now." Which response is generally most appropriate? Give a brief, undetailed answer. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate personal and social history. Direct questioning about domestic violence in the home should be: a routine component of history taking with female patients. Mrs. G reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: CAGE questionnaire. A tool used to screen adolescents for alcoholism is the: CRAFFT. 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: leave the child sitting in the father's lap while you talk to the father. Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health? Propensity for risk taking Pain is difficult to assess in older adults because: sharp pain may be felt as a dull ache. Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(n): functional assessment. JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history. problem or focused Which of the following are connection types of communication? (Select all that apply.) Good eye contact Avoiding being judgmental Respecting silence Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing a. suture removal. b. trachea care and suctioning. c. wet-to-dry dressing changes. d. patient bathing. e. tube feedings. ANS: B Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. REF: p. 31 2 Standard Precautions apply to all patients a. with bloodborne infections. b. with infected, draining wounds. c. in intensive care units. d. receiving care in hospitals. e. believed to have an infectious disease. wash hands with mild soap after removing gloves and then dry the hands thoroughly. d. use well-powdered gloves with an increased protein content. e. use oil-based creams or lotions before donning gloves. ANS: C The recommendations are to use nonlatex gloves for situations not likely to involve infectious materials, not to use oil- based creams or lotions, to wash hands with mild soap and dry thoroughly after removing gloves, and to use powder-free latex gloves with a reduced protein content. Forcefully snapping off latex gloves disperses latex molecules in the air, which can lead to the most severe reactions. REF: p. 32 6 Which patient position is useful for auscultating heart tones? a. Lithotomy b. Dorsal recumbent c. Left lateral recumbent d. Right Sims e. Prone ANS: C The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. REF: p. 32 7 Which technique is used during the history taking and the physical examination process? a. Auscultation b. Instrumentation c. Palpation d. Percussion e. Inspection ANS: E Inspection is the technique used while gathering and validating data during the history taking and the actual hands-on physical examination. REF: p. 32 8 Which examination technique should be used first? a. Deep palpation b. Inspection c. Percussion d. Auscultation e. Light palpation ANS: B Inspection, the process of systematic observation, is the first technique used in an examination. REF: p. 32 9 The use of secondary, tangential lighting is most helpful in the detection of a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. e. variations in texture and mobility. ANS: D Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. REF: p. 33 10 A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? a. Drape the patient and observe the rectal area. b. Tell the patient that his physician will be notified of his problem. c. Tell the patient that you will ask the male nurse on the next shift to check on the problem. d. Give the patient an ice pack to apply to the area. e. Give the patient a specimen cup to collect the drainage. ANS: A Necessary exposure for direct observation, while adjusting for modesty, is warranted. The complaint warrants validation before referring or delegating. REF: p. 33 11 You are conducting a head to toe examination as part of a patient’s preventive health assessment. The room has adequate lighting, and you have access to both sides of the examining table. What position should you assume while conducting this examination? a. Behind the patient b. To the left side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient e. Standing in front of the patient ANS: D Although conventionally taught to approach an examination from the patient’s right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. REF: p. 33 12 Which part of the examiner’s hand is best for palpating vibration? a. Dorsal surface b. The thumb c. Fingertips d. Ulnar surface and base of the fingers e. Finger pads ANS: D The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus. REF: p. 33 13 The dorsal surface of the hand is most often used for the assessment of a. crepitus. b. thrills. c. texture. d. vibration. e. temperature. ANS: E The dorsal surface, or back of the hand, can best feel for warmth. REF: p. 33 14 When conducting the abdominal examination, after you inspect, you proceed next to a. percussion. b. deep palpation. c. the rectal examination. d. auscultation. e. light palpation. ANS: D Auscultation precedes palpation or percussion of the abdomen because these techniques can stimulate peristalsis, which may alter the correct assessment of abdominal sounds. The rectal examination is performed at a point after a full abdominal examination is completed. REF: p. 35 15 The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder the percussion tone. b. The less dense the medium, the louder the percussion tone. c. The more hollow the area percussed, the quieter the percussion tone. d. Percussion over bony areas produces the loudest percussion tones. e. Percussion tones are produced by the structure immediately beneath the skin. ANS: B Percussion sounds vary according to the tissue being percussed. Whereas less dense tissue (e.g., over a normal lung) produces a loud tone, more dense tissue (e.g., a muscle) produces a softer tone. Percussion tones arise from vibrations 4 to 6 cm deep in the body tissue. REF: p. 34 16 Expected normal percussion tones include a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany ANS: A The dominant hand’s middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. REF: p. 34 Which cranial nerves innervate the face? A. II and V B. III and VI C. V and VII D. VIII and IX C. Facial muscles are innervated by Cranial nerve V & VII. The parotid, submandibular, and sublingual salivary glands: A. impair carbohydrate digestion. B. inhibit dental caries. C. lubricate nasal surfaces. D. promote dry mouth. B. T parotid, submandibular, and sublingual salivary glands are paired and produce saliva which moistens the mouth, inhibits formation of dental caries, and initiates digestion of carbohydrates Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at: A. C1 to C2. B. C2 to C3. C. C3 to C4. D. C4 to C5. D. C 4 to C 5: C4 and C5 or C5 and C 6 provide the greatest horizontal mobility in adults In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: A. cricoid. B. hyoid. C. thyroid. D. sternocleidomastoid. A. The thyroid cartilage is shaped like a shield, its notch on the upper edge marking the level of the bifurcation of the common carotid artery. The cricoid cartilage is the uppermost ring of the tracheal cartilages. Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence? A. Coronal sutures B. Hyoid and cricoid cartilages C. Mandible and maxilla bones D. Nose and thyroid cartilages D. In the male adolescent, the nose and thyroid cartilage enlarge, and facial hair develops, emerging first on the upper lip, then the cheeks, lower lip and chin. Spaces between the cranial bones accommodate: A. brain growth. B. cartilage formation. C. muscular expansion. D. nerve regeneration. A. Spaces between the cranial bones permit the expansion of the skull to accommodate brain growth. Upgrade to remove ads Only $1/month When examining the skull of a 4-month-old baby, you should normally find: A. closure of the anterior fontanel. B. closure of the posterior fontanel. C. ossification of all sutures. D. overlap of cranial bones. B. Closure of the posterior fontanel: Ossification of the sutures begins after completion of brain growth at about 6 years of age, and is finished by adulthood The fontanels ossify earlier, with the posterior fontanel usually closing by 2 months of age and the anterior fontanel closing by 24 months of age. The brown or tan pigmentation on the forehead, nose, and malar prominence of some pregnant women is called: A. hormonal acne. B. erythema. C. alopecia. D. chloasma. D. Chloasma - "mask of pregnancy" blotchy, brownish hyperpigmentation of the face particulary over the malar prominences and the forehead. Which of the following is an expected change in the assessment of the thyroid during pregnancy? A. Palpation of the gland becomes difficult. B. A bruit is auscultated. C. Inspection reveals a goiter. D. The gland is tender upon palpation. B. A bruit may be heard because of increased vascularity. Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of: A. hypothyroidism. B. hyperthyroidism. C. thyroid cancer. D. thyroid cyst. B. Hyperthyroidism - if thyroid gland is enlarged, auscultate for vascular sounds with the bell. In a hypermetabolic state, the blood supply is dramatically increased and a vascular bruit, a soft rushing sound may be heard. Ms. Galvan is a 22-year-old secretary who comes to the clinic with headaches of 6 weeks' duration. She tells the office assistant about her heavy schedule, including part- time work and evening classes. Her vital signs are normal. Which information is most appropriate to Ms. G.'s history? A. Current medications B. Elimination patterns C. Immunization status D. Previous pregnancies A. current medications - anticonvulsants, antiarrhythmics, beta blocks, CCB, oral contraceptives, serotonin antagonists or agnoists, selective serotonic reuptake inhibitors, antidepressants, NSAIDs, narcotis, caffeine-containing medications. Observation during history taking is the best way to examine for: A. head position. B. scalp lice. C. thyroid size. D. tracheal alignment. A. head position - the patient's head should be examined during the inspection for position and facial features throughout the history and physical examination. During a head and neck assessment of a neonate, it is important to screen for: A. the presence of torticollis. B. signs and symptoms of cerebral palsy. C. uneven movement of the eyes. D. unilateral movement of the tongue. A. The presence of torticollis - often result of birth trauma or intrauterine malposition. To detect bruits in the head and neck region, you should place the bell of the stethoscope: A. above the temporal and sagittal regions. B. below the eyes and on the coronal suture. C. near the zygomatic and nasal areas. D. on the temporal region and below the occiput. D. on the temporal region and below the occiput - If you suspect a vascular anomaly of the brain, use the bell of the stethoscope and listen over the temporal region, over the eyes and below the occiput. During physical examination of a 30-year-old Chinese man, you notice slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to: A. ask the patient if this characteristic runs in his family. B. perform monofilament testing on the face. C. consult with the physician regarding laboratory tests needed. D. record the finding in the patient's chart. A. ask the patient if this characteristic runs in his family A bruit, or blowing sound, over the skull or temporal region of an adult indicates a: A. degenerative change. B. hyperthyroid storm. C. skull fracture. D. vascular anomaly. D. Whether she is particularly stressed or overworked. Sign of muscular tension Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: A. parotid gland tumor. B. branchial cleft cyst. C. Stensen duct stone. D. thyroglossal duct cyst. D. Thyroglossal duct cyst. Freely movable cystic mass in neck midline, moves upward with tongue protrusion and swallowing. Moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are characteristics associated with: A. Cushing syndrome. B. Graves disease. C. myxedema. D. systemic lupus erythematosus. B. Graves disease Which of the following findings would be consistent with fetal alcohol syndrome (FAS)? A. Corneal clouding B. Eye slanting C. Mild ptosis D. Symmetrical bulging fontanels C. Mild ptosis. FAS - most common causes of acquired mental retardation. Note poorly formed philtrum; widespread eyes, with inner epicanthal folds and mild ptosis; hirsute forehead; short nose; and relatively thin upper lip. The premature union of cranial sutures that involves the shape of the head without mental retardation is: A. craniosynostosis. B. encephalocele. C. microcephaly. D. myxedema. A. craniosynostosis - premature fusion of one of the sutures before brain growth complete. The examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of the immune system because of the location of which organ? a. Transverse colon b. Liver c. Spleen d. Stomach e. Pancreas c. Spleen When palpating the abdomen, you should note whether the liver is enlarged in the: A. Left lower quadrant B. Mid-epigastric region C. Periumbilical area D. Right upper quadrant D. Right upper quadrant Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: A. Gallbladder B. Kidney C. Liver D. Spleen C. Liver You are suspecting mononucleosis as part of the differential diagnosis for an adolescent patient complaining of a sore throat. What abdominal organ would you expect to be enlarged: A. Gallbladder B. Kidney C. Pancreas D. Spleen D. Spleen Before performing an abdominal examination, the examiner should: A. Ascertain the patient's HIV status B. Have the patient empty his or her bladder C. Put on double gloves D. Completely disrobe the patient B. Have the patient empty his or her bladder When examining a patient with tense abdominal musculature, a helpful technique for the patient: A. Hold his or her breath B. Sit upright C. Flex his or her knees D. Raise his or her head off the pillow C. Flex his or her knees Upgrade to remove ads Only $1/month Inspection of the abdomen reveals purplish stretch marks on the abdomen. What other signs or symptoms would you expect to find? A. Weight loss, increase bone density, menstrual irregularities, hypotension B. Weight gain, decrease bone density, menstrual irregularities, hypertension C. Weight loss, decrease bone density, normal menstrual, hypertension D. Weight gain, increase bone density, menstrual irregularities, hypotension B. Weight gain, decrease bone density, menstrual irregularities, hypertension What types of symptoms would you expect in a patient with visible intestinal peristalsis? A. Severe spasmodic pain in the umbilical region with findings of distension, localized tenderness B. Severe, unrelenting RUQ and right subscapular pain with findings of RUQ tenderness and rigidity, + Murphy's sign C. LLQ cramping pain with findings of fever, suprapubic tenderness and muscle guarding D. Back pain associated with throbbing midline mass A. Severe spasmodic pain in the umbilical region with findings of distension, localized tenderness After thorough inspection of the abdomen, the next assessment step is to: A. Percuss B. Palpate C. Auscultate D. Perform a rectal examination C. Auscultate An examiner can recognize a friction rub in the liver by a sound that is: A. Clicking, gurgling, and irregular B. High pitched and associated with respirations C. Loud, prolonged, and gurgling D. Soft, low-pitched, and continuous B. High pitched and associated with respirations Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: A. Descending aorta B. Lower liver border C. Medial border of the spleen D. Upper right kidney B. Lower liver border Auscultation for renal artery bruits is most important for patients with: A. Angina pectoris B. Hypertension C. Gout D. Migraines B. Hypertension When percussing a spleen, distorted sounds are most likely caused by: A. Colonic air B. Distended bladder C. Empty stomach D. Solid mass A. Colonic air A 23-year- old man comes to the urgent care clinic with intense left flank pain. One patient answer to the history of the present illness questions that further supports a tentative diagnosis of nephrolithiasis is: A. "My urine has been bright yellow." B. "I have had a fever of chills for 2 days." C. "I also have a headache and neck ache." D. "I have pain in my left groin and left testicle." D.All of the above E. Two of the above A. Hemorrhoids B. Ulcerative colitis E. Two of the above What is the most discriminating feature in a patient with suspected appendicitis A. Migration of pain from the periumbilical area to the right lower quadrant B. Migration of pain from the right lower quadrant to the periumbilical area C. Nausea and vomiting D. Hematuria and pyuria A. Migration of pain from the periumbilical area to the right lower quadrant Which of the following patients will present with an unremarkable examination? A. Crohn's disease B. Gastroesophageal reflux disease C. Cholecystitis D. Pancreatitis B. Gastroesophageal reflux disease A patient presents with ecchymosis (bruising) on the right and left flanks. This is describes as and is found in . A. Grey Turner sign / pancreatitis B. Cullen's sign / ulcerative colitis C. Grey Turner sign / cholelithiasis D. Cullen's sign / diverticula A. Grey Turner sign / pancreatitis Your patient's complaint is repeated pencil-like stools. Further examination should include A. Stool culture B. Parasite testing C. Digital rectal exam D. Prostate examination A. Stool culture Tarry black stool should make you suspect A. Internal hemorrhoids B. Rectal fistula C. Upper intestinal bleeding D. Prostatic cancer C. Upper intestinal bleeding Upgrade to remove ads Only $1/month What would you hear with percussion over solid organs? dullness What would you hear with percussion over hollow organs? tympany What would you hear with percussion with healthy abdominal tissue? resonance List 2 diagnosis that will produce visible peristalsis? - Hirschsprungs disease - intestinal obstruction Your 55 year old male construction worker presents with the following signs and symptoms: heartburn, regurgitation, dysphagia, and chest pain. There is no history of cardiac involvement. What cellular pathophysiological processes take place (in the causal organ)? GERD-- esophageal metaplasia List 5 substances produced by the stomach: - mucous - HCl - proteases - gastrin - intrinsic factor List 3 hormones produced by the liver: - angiotensinogen - thromboprotein - hepcidin Your patient feels like he has to have a bowel movement. They try, but nothing is expelled. This is called? It is caused by? tenesmus; ulcerative colitis Your patient presents to your office complaining of stools that are black and tar-like. This is documented as? Melena The differential diagnosis of female patient who present with indigestion should include what major system (not GI)? cardiovascular system An older patient has been diagnosed with pernicious anemia. The anemia could be related to what pathological process in the stomach? Crohn's Patients with malabsorption syndrome are most likely to have what type of stools? greasy diarrhea --> steatorrhea List 3 types of patients most susceptible to cholelithiasis? - obese - pregnant - estrogen (older women) List 4 causes of paralytic ileus? - trauma/spinal cord injury - infection - surgery - age or opioids What disease is associated with the "string sign"? Crohn's In older adults, overflow fecal incontinence is commonly caused by... a. malabsorption b. parasitic diarrhea c. Meckel diverticulum d. fistula formation e. fecal impaction e. fecal impaction To correctly document absent bowel sounds, one must listen continuously for... a. 30 seconds b. 1 minute c. 3 minutes d. 5 minutes e. 10 minutes d. 5 minutes When palpating the aorta, a prominent lateral pulsation suggests... a. aortic aneurysm b. normal pulsation c. renal artery fistula d. vena cava varicosity e. coarctation a. aortic aneurysm After thorough inspection of the abdomen, the next assessment step is to... a. percuss b. palpate nonpainful areas c. auscultate d. perform a rectal examination e. palpate painful areas c. auscultate To assess for liver enlargement in an obese person, you should... a. use the hook method b. test for cutaneous hypersensitivity c. auscultate using the scratch technique d. attempt palpation during deep exhalation e. have the patient lean over at the waist c. auscultate using the scratch technique Peristalsis of intestinal contents is under the control of... a. cognitive processes b. gravity c. the autonomic nervous system d. the fluid content of the stomach e. cerebellum c. the autonomic nervous system Upgrade to remove ads Only $1/month e. diverticulitis What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. duodenum b. ileum c. jejunum d. falciform ligament e. pylorus a. duodenum Contraction of the gallbladder propels bile into the... a. stomach b. duodenum c. jejunum d. ileum e. cecum b. duodenum When examining a patient with tense abdominal musculature, a helpful technique is to have the patient... a. hold his or her breath b. sit upright c. flex his or her knees d. raise his or her head off the pillow e. fully extend the legs c. flex his or her knees A 1-month-old boy has been vomiting for 2 weeks. How is the symptom of gastroesophageal reflux disease (GERD) and pyloric stenosis further differentiated in this child's assessment? a. vomiting becomes projectile with GERD b. the infant has regurgitation with pyloric stenosis c. an olive-sized mass of the right upper quadrant (RUQ) occurs with GERD d. normal stools are expected with pyloric stenosis e. the fontanel becomes sunken and the baby is emaciated with pyloric stenosis e. the fontanel becomes sunken and the baby is emaciated with pyloric stenosis The superior most part of the stomach is the... a. body b. fundus c. pylorus d. cardiac orifice e. pyloric orifice b. fundus Auscultation of borborygmi is associated with... a. gastroenteritis b. peritonitis c. satiety d. paralytic ileus e. stenotic arteries a. gastroenteritis Before performing an abdominal examination, the examiner should... a. ascertain the patients HIV status b. have the patient empty his or her bladder c. don double gloves d. completely disrobe the patient e. uncover only the painful areas of the abdomen b. have the patient empty his or her bladder Cullen's sign and Grey Turner's sign are considered pathognomic for... a. acute appendicitis b. polycystic kidney disease c. an aortic aneurysm d. acute cholecystitis e. hemorrhagic pancreatitis e. hemorrhagic pancreatitis An examiner can recognize a friction rub in the liver by a sound that is.. a. clicking, gurgling, and irregular b. high pitched and associated with respirations c. loud, prolonged, and gurgling d. soft, low-pitched, and continuous e. low pitched, tinkling, and unrelated to respirations b. high pitched and associated with respirations Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the ureter. What condition will be documented in this patient's health record? a. glomerulonephritis b. hydronephrosis c. pyelonephritis d. renal abscess e. renal artery emboli b. hydronephrosis A patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low- grade fever attributed to eating some "bad food" 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis? a. malaise b. low-grade fever c. hypoactive bowel sounds d. soft, rounded abdomen e. abdominal pain c. hypoactive bowel sounds Visible intestinal peristalsis may indicate... a. normal digestion b. intestinal obstruction c. increased pulse pressure of aorta d. aortic aneurysm e. paralytic ileus b. intestinal obstruction Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? a. intussusception b. kidney stones c. meconium ileus d. pyloric stenosis e. necrotizing enterocolitis a. intussusception The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it... a. only affects the GI tract b. is one cause of malabsorption syndrome c. is a curable condition with medical intervention d. is the most frequent cause of diarrhea in general practice e. is a common genetic disorder b. is one cause of malabsorption syndrome Which organ(s) are located in the retroperitoneal space? a. kidneys b. lungs c. spleen d. gallbladder e. liver a. kidneys Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the... a. spleen b. kidney c. liver d. pancreas e. gallbladder c. liver Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the... a. descending aorta b. lower liver boarder c. medial boarder of the spleen d. upper right kidney ridge e. stomach b. lower liver boarder The most common congenital anomaly of the gastrointestinal tract is... a. biliar atresia b. meconium ileus c. intussusception When palpating the abdomen, you should note whether the liver is enlarged in the... a. left upper quadrant b. midepigastric region c. periumbilical area d. right upper quadrant e. right lower quadrant d. right upper quadrant Inspection of the abdomen should begin with the patient supine and the examiner... a. seated on the patients right side b. standing at the foot of the table c. standing at the patients left d. walking around the table e. seated on the patients left side a. seated on the patients right side The majority of nutrient absorption takes place in the... a. stomach b. small intestine c. cecum d. transverse colon e. descending colon b. small intestine A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured? a. gallbladder b. liver c. spleen d. stomach e. colon c. spleen Which organ is part of the alimentary tract? a. pancreas b. stomach c. gallbladder d. liver e. spleen b. stomach One major function of the liver is to... a. secrete pepsin b. emulsify fats c. store glycogen d. absorb bile e. produce insulin c. store glycogen Urinary incontinence that occurs from the inability to hold urine when the stimulus to urinate is perceived is called...incontinence. a. paralytic b. urge c. overflow d. functional e. stress b. urge When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous system? a. arterial bruit b. gastric rumbling c. renal hyperresonance d. borborygmi e. venous hum e. venous hum Which of the following is true regarding the stomach? a. it lies in the lower abdominal cavity b. it secretes gastric lipase that serves to digest protein c. very little absorption takes place in the stomach d. the stomach produces most of the body's bile e. pancreatic enzymes directly enter the stomach c. very little absorption takes place in the stomach The major function of the large intestine is.. a. water absorption b. food digestion c. carbohydrate absorption d. mucous absorption e. glycogen breakdown a. water absorption 1. In adults, the length of the external auditory canal is cm. A. 0.5 B. 1 C. 2.5 D. 4 E. 5 C. 2.5 2.The middle ear contains the A. cerumen and sebaceous glands. B. umbo and malleus. C. vestibule and cochlea. D. pars tensa and semicircular canals. E. helix and antihelix. B. umbo and malleus. 3. The middle ear is normally filled with A. mucous collections. B. blood. C. serous fluid. D. cerebrospinal fluid. E. air. E. air. 4. The hair cells of Corti and membrane of Corti A. maintain equilibrium. B. protect the ear from foreign particles. C. stimulate the eighth cranial nerve. D. transmit vibrations to the ossicles. E. produce a waxy lubricant. C. stimulate the eighth cranial nerve. 5. The organ of Corti is a coiled structure located inside the A. cochlea in the inner ear. B. pars flaccida in the tympanic membrane. C. eustachian tube. D. lateral aspect of the pinna. E. tragus. A. cochlea in the inner ear. 6. Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, and yawning? A. Eustachian tube B. Inner ear C. Semicircular canals D. Triangular fossa E. Oval window A. Eustachian tube Upgrade to remove ads Only $1/month 7.The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the sinuses. A. ethmoid B. frontal C. maxillary D. cribriform E. sphenoid C. maxillary 8.A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the A. sphenoid and frontal sinuses. B. maxillary and frontal sinuses. C. maxillary sinuses only. D. sphenoid sinuses only. E. ethmoid and frontal sinuses. B. maxillary and frontal sinuses D. 1500 to 2000 Hz E. Greater than 2000 Hz C. 500 to 1000 Hz 21.You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to A. remove all cerumen from the canal. B. make sure the speculum is sealed from outside air. C. squeeze the bulb with more force. D. insert the speculum to depth of 2 cm. E. use a smaller plastic speculum. B. make sure the speculum is sealed from outside air. 22.An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or A. digestive disorder. B. skeletal anomaly. C. renal disorder. D. Ménière disease. E. heart defect. C. renal disorder. 23.When conducting an adult otoscopic examination, you should A. position the patient's head leaning toward you. B. grasp the handle of the otoscope as you would a baseball bat. C. select the largest speculum that will fit in the canal. D. ask the patient to keep his or her eyes closed. E. pull the auricle down and forward. C. select the largest speculum that will fit in the canal 24.Normal tympanic membrane color is A. amber. B. chalky white. C. greenish. D. pearly gray. E. red. D. pearly gray 25.Bulging of an amber tympanic membrane without mobility is most often associated with A. a middle ear effusion. B. a healed tympanic membrane perforation. C. impacted cerumen in the canal. D. repeated and prolonged crying cycles. E. a Pseudomonas infection of the auditory canal. A. a middle ear effusion. 26.In the presence of otitis externa, tympanic membrane perforation, or a myringotomy tube, you should A. avoid performing otoscopic examinations. B. clean the inner ear with soap. C. instill alcohol into the ear. D. never use a cerumen spoon. E. avoid instilling fluids. E. avoid instilling fluids 27.When hearing is evaluated, which cranial nerve is being tested? A. III B. IV C. VIII vestibulocochlear nerve D. IX E. XII C. VIII vestibulocochlear nerve 28.Speech with a monotonous tone and erratic volume may indicate A. otitis externa. B. hearing loss. C. serous otitis media. D. sinusitis. E. dry cerumen B. hearing loss. 29.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. E. lateralization of sound. 30.To perform the Rinne test, place the tuning fork on the A. top of the head. B. mastoid bone. C. forehead. D. preauricular area. E. occiput. B. mastoid bone. Upgrade to remove ads Only $1/month 31.You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, the air conduction to bone conduction-to-ratio was less than 2:1. You interpret these findings as suggestive of A. a defect in the inner ear. (Weber test=sensorineural issue. AC(air conduction)>BC(bone conduction)) B. a defect in the middle ear. C. otitis externa. D. impacted cerumen. E. serous otitis. A. a defect in the inner ear. (Weber test=sensorineural issue. AC(air conduction)>BC(bone conduction)) 32.Nasal symptoms that imply an allergic response include A. purulent nasal drainage. B. bluish gray turbinates. ("Turbinates that appear bluish gray or pale pink with a swollen, boggy consistency may indicate allergies"-Seidel p.243) C. small, atrophied nasal membranes. D. a firm consistency of the turbinates. E. a deviated septum. B. bluish gray turbinates. 33.When you ask the patient to identify smells, you are assessing which cranial nerve? A. I (olfactory nerve) B. II C. III D. IV E. VIII A. I 34.Pallor of the lips and mucous membranes is one sign of A. anemia. B. hyperbilirubinemia. C. liver problems. D. carbon monoxide poisoning. E. Peutz-Jeghers syndrome. A. anemia. (pallor indicative of reduced blood flow) 35.A smooth red tongue with a slick appearance may indicate A. a niacin or vitamin B12 deficiency. B. oral cancer. C. recent use of antibiotics. D. a fungal infection. E. a geographic tongue. A. a niacin or vitamin B12 deficiency 36.White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are A. Fordyce spots. B. aphthous ulcers. (canker sores) C. Stensen ducts. D. leukoedema. E. angular cheilitis. B. aphthous ulcers. (canker sores 37.A hairy tongue with yellowish brown to black elongated papillae on the dorsum A. is indicative of oral cancer. B. is sometimes seen after antibiotic therapy. C. usually indicates a vitamin deficiency. D. usually indicates anemia. E. is characteristic of a geographic tongue. B. is sometimes seen after antibiotic therapy. 50.An alternative to "ahhh" suggests A. having the clinician gently stroke the soft palate with the tongue blade B. have the patient exhale and hold the breath for a few seconds with the mouth open C. having the clinician place a small amount on water in the patients nose D. have the patient inhale and hold the breath for a few seconds with the mouth open D. have the patient inhale and hold the breath for a few seconds with the mouth open 51.A patient presenting with strep throat likely has A. Fever B. Cervical andenopathy C. Cough D. Pharyngeal exudate E. All of the above E. All of the above 52.An earlobe crease may indicate A. Serous otitis media B. Purulent otitis media C. COPD D. CAD E. ICD-9 D. CAD 53.Consumption of which food has the highest statistical association with serous otitis media A. Wheat B. Corn C. Egg D. Dairy E. Peanut D. Dairy 54.A Dix-Hallpike Maneuver is most useful in the diagnosis of A. BPV B. Meniere's C. Vestibular neuronitis D. Labrynthitis E. Choesteatoma A. BPV 55.Which hearing test has the highest likelihood ratio of predicting hearing loss on PE. A. Abnormal whispered voice test B. Cannot hear strong finger rubbing C. Cannot hear faint finger rubbing D. Rinne Test E. Weber Test B. Cannot hear strong finger rubbing. The body handles excess carbohydrate ingestion by: ... Macronutrients are so named because they: a. have high molecular weights. b. form long chemical chains. c. tend to increase waist measurements. d. are required in large amounts. ANS: D Carbohydrates, protein, and fat are referred to as macronutrients because they are required in large amounts. The body handles excess carbohydrate ingestion by: a. storing it as fat. b. raising the metabolic rate. c. excreting it in urine and stool. d. enzyme degradation. ANS: A Excess carbohydrates, not used for fueling the body's demands, are stored in fatty tissues. The body does not handle excess carbohydrate ingestion by raising the metabolic rate or by enzyme degradation. Excess carbohydrate is not excreted; it is stored. A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly: a. fruit and vegetables. b. lean meat and fish. c. sandwiches and diet drinks. d. pasta and chicken. ANS: B Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. Fruits and vegetables, sandwiches and diet drinks, and pasta and chicken have moderate levels of needed carbohydrates. Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as: a. providing an energy source for the brain. b. building and maintaining tissues. c. participating in specific detoxifying metabolic pathways. d. synthesizing and regulating hormones. ANS: B The major functions of proteins include building and maintaining tissues, regulating water and acid-base balance, and acting as precursors for enzymes, antibodies, and several hormones. Carbohydrates, not proteins, provide an energy source for the brain. Proteins do not participate in detoxifying metabolic pathways or synthesize and regulate hormones. Mr. Miles is a 45-year-old man who is being evaluated for obesity. Advising Mr. Miles to reduce which macronutrient will produce the greatest calorie reduction per gram? a. Carbohydra te b. Protei n c. Fa t d. All provide the same number of calories per gram. ANS: C Reducing fats will produce the greatest calorie reduction per gram. Carbohydrates and proteins supply 4 calories per gram, and fats supply 9 calories per gram. Upgrade to remove ads Only $1/month In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for: a. glycogen storage in the liver. b. normal growth and development. c. myocardial cell function. d. building and maintaining tissues. ANS: B Linoleic acid, found abundantly in milk and dairy fats, is required for normal growth and development. Recently, it has been suggested that it can reduce body fat in overweight persons, as well as having cancer-fighting properties. Carbohydrates provide for glycogen storage and energy for myocardial cell function. Proteins are essential for building and maintaining tissues. ANS: B Ninety-nine percent of bone is composed of calcium. A deficiency in calcium would lead to osteoporosis. Phosphorus deficiency is rare. Iron deficiency results in pallor, lethargy, anorexia, and hypochromic microcytic anemia. Zinc deficiency results in decreased wound healing, hypogonadism, anemia, hair loss, diarrhea, and altered taste. Mr. Williams, a 62-year-old patient, presents for a physical examination. You suspect a vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency? a. Spinal curvature and bowed legs b. Night blindness and dry eyes c. Neuropathy and seizures d. Nausea and insomnia ANS: A Vitamin D deficiency can lead to rickets, a disease manifested by spinal curvature and bowed legs. Night blindness and dry eyes result from vitamin A deficiency. Neuropathy and convulsions result from vitamin B6 deficiency. Nausea and insomnia result from a biotin deficiency. Which of the following is the most vital nutrient? a. Protei n b. Carbohydra te c. Fa t d. Water ANS: D Water is the most vital nutrient. A person can exist without food for several weeks but without water for only a few days. Under normal circumstances, how much water is lost daily by the body? a. 1 to 1.5 liters b. 2 to 2.5 liters c. 3 to 4 liters d. 5 to 6 liters ANS: B Under normal circumstances, approximately 2 to 2.5 liters of water is lost daily. The largest proportion of total energy expenditure by the body occurs a. thermogenes is. b. digestive processes. c. resting energy. d. physical activity. ANS: C Resting energy expenditure contributes the largest proportion of total energy expenditure by the body. Which of the following is the most accurate reflection of an individual's food intake? a. Twenty-four-hour diet recall b. Food diary c. Computerized nutrient analysis d. Serum protein assay ANS: B The food diary is a record of intake as it happens, making this method the most accurate reflection of an individual's food intake. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? a. Ascorbic acid b. Vitamin B12 c. Folat e d. Fiber ANS: B The nutrients that may be deficient in a vegetarian diet, if not carefully planned, include proteins, calcium, iron, vitamin B12, and vitamin D. When using rule of thumb estimates of energy needs of healthy adults, how many kcal/kg are required to maintain the individual's current weight? ANS: B The requirement for weight maintenance is 30 kcal/kg. Which age group requires the highest percentage of dietary fat intake? a. Infants and children up to 2 years of age b. Children between 2 and 10 years of age c. ANS: B The hypodermis layer consists of adipose tissue that serves to generate heat and provide insulation, shock absorption, and a reserve of calories. REF: p. 115 Sweat glands, hair, and nails are all formed from: a. basement membranes under cellular strata. b. closely packed squamous cells. c. invaginations of epidermis into dermis. d. papillae that penetrate the epidermis. ANS: C Skin appendages are formed embryonically when the epidermis invaginates into the dermis. REF: p. 115 The secretory activity of the sebaceous glands is stimulated by: a. body heat. b. ambient temperature. c. sex hormones. d. dietary protein. ANS: C The sebaceous glands, when stimulated by the sex hormones, produce a lipid-rich substance that keeps the skin moist. REF: p. 116 Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth? a. Cuticl e b. Perionychiu m c. Matri x d. Nail bed ANS: C The white crescent-shaped area beyond the proximal nail fold is called the matrix, which is the site of new nail growth. REF: p. 116 Mrs. Leonard brings her newborn infant into the pediatrician's office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia because of: a. the presence of coarse terminal hair. b. desquamation of the stratum corneum. c. their covering of vernix caseosa. d. a poorly developed subcutaneous fat layer. ANS: D Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat. REF: p. 116 Upgrade to remove ads Only $1/month Mrs. Mulligan brings her 16-year-old son into the office for a sports physical examination. As the health care provider, you explain that normal hormone- related changes of adolescence include: a. increased oil production. b. slowed hair growth. c. depleted apocrine glands. d. decreased sebaceous gland activity. ANS: A During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne. REF: p. 116 Expected hair distribution changes in older adults include: a. increased terminal hair follicles on the scalp. b. more prominent axillary and pubic hair production. c. increased terminal hair follicles to the tragus of men's ears. d. more prominent peripheral extremity hair production. ANS: C The transition from a vellous to terminal hair pattern occurs in older men at the nares and tragus. REF: p. 117 Brittle nails are typical findings in: a. adolescent s. b. infant s. c. pregnant women. d. older adults. ANS: D Older adults typically have decreased peripheral circulation to the nails, causing the nails to develop longitudinal ridges that are more brittle and susceptible to splitting into layers. REF: p. 117 Mrs. Franklin is a 68-year-old patient who presents to the office with a complaint that her nails do not seem to be growing. As the health care provider, you explain to her that the nails of older adults grow slowly because of: a. decreased circulation. b. dietary deficiencies. c. fungal infections. d. low hormone levels. ANS: A Decreased circulation to the nails of older adults causes nail growth retardation. REF: p. 117 As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include: a. an olive complexion. b. repeated trauma or irritation to skin. c. history of allergic reactions to sunscreen. d. dark eyes and hair. a. Whether she had unprotected sex b. Whether she has a history of diabetes mellitus c. Whether she had unusual bleeding problems d. Whether she eats a lot of yellow and orange vegetables ANS: D In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced. Whether she had unprotected sex, a history of diabetes mellitus, or unusual bleeding problems would not be relevant when assessing the jaundiced skin. REF: p. 119 Upgrade to remove ads Only $1/month You are examining a pregnant patient and have noted a vascular lesion. When you blanch over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a: a. telangiectasi a. b. spider angioma. c. petechia e. d. purpura. ANS: B Spider angiomas are dilated arterioles. A network of dilated capillaries radiate from the center arteriole, outward like a spider's legs. Spider angiomas are often associated with high estrogen levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Telangiectasis refill erratically. Petechiae and purpura do not blanch. REF: p. 123 Small, minute bruises are called: a. ecchymose s. b. petechia e. c. spider veins. d. telangiectasias. ANS: B Petechiae are smaller than 0.5 cm in diameter. Ecchymoses are larger than 0.5 cm in diameter. Spider veins and telangiectasias are vascular lesions. REF: p. 124 A flat, nonpalpable lesion is described as a macule if the diameter is: a. larger than 1 cm. b. smaller than 1 cm. c. 3 cm exactly. d. too irregular to measure. ANS: B A macule, by definition, is a flat, circumscribed area smaller than 1 cm in diameter and is measurable. An example of a macular rash is measles. REF: p. 126 Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4- × 3-cm, rough, elevated area of psoriasis. This is an example of a: a. plaque . b. patch. c. macul e. d. papule . ANS: A A plaque, by definition, is an elevated, firm, rough lesion with a flat top surface larger than 1 cm in diameter, as seen in someone with, for example, psoriasis. REF: p. 126 The nurse inspects an annular lesion. Which type of additional lighting source should be used for further assessment? a. Fluorescent lighting b. Wood's lamp c. Goose-neck lamp d. Sunlight ANS: B Annular lesions are characteristic of tinea, which are fluorescing lesions that illuminate as yellow-green under a Wood's lamp. REF: p. 133 Skin turgor checks are performed to determine the: a. temperature of the skin. b. hydration status. c. actual age. d. extent of an ecchymosis. ANS: B Skin will remain tented if the patient is dehydrated or will not tent if edema is present. REF: p. 140 You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish: a. vascular from nonvascular lesions. b. furuncles from folliculitis lesions. c. fluid-filled lesions from solid cysts or masses. d. herpes zoster from varicella. ANS: C Transillumination is used to determine the presence of fluid in cysts and masses. Fluid- filled lesions will transilluminate with a red glow, and solid masses will not transilluminate. REF: p. 133 Fluorescing lesions are best distinguished using a(n): a. incandescent lamp. b. magnifying glass. c. transilluminato r. d. Wood's lamp. ANS: D Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow- green color ANS: D Persons with chronic atopic or allergic conditions tend to rub the eyes sufficiently to cause an extra crease or pleat of skin below the eye, called the Dennie-Morgan fold. REF: p. 140 Linea nigra is commonly found on the abdomens of: a. infants and children. b. adolescent s. c. pregnant women. d. older adults. ANS: C Pregnant women commonly develop pigmentation of the abdomen from the symphysis pubis to the top of the fundus in the midline. REF: p. 140 Cherry angiomas are a common finding in: a. adults older than 30 years. b. newborn s. c. pregnant women. d. sunbather s. ANS: A Cherry angiomas occur in almost everyone older than 30 years and increase numerically with age. REF: p. 142 Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: a. cutaneous tags from lentigines. b. furuncles from folliculitis. c. sebaceous hyperplasia from eczema. d. seborrheic keratoses from actinic keratoses. ANS: D Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination. REF: p. 142 Age spots are also called: a. seborrheic keratoses. b. solar lentigines. c. cutaneous horns. d. acrochordo n. ANS: B Solar lentigines are irregular, round, gray-brown lesions with a rough surface that occur in sun-exposed areas and are referred to as age spots. REF: p. 143 The most common inflammatory skin condition is: a. cutis marmorata. b. eczematous dermatitis. c. intradermal nevus. d. pityriasis rosea. ANS: B The most common inflammatory skin disorder is eczematous dermatitis. REF: p. 144 Which of the following is a noncandidal fungal infection? a. Pityriasis rosea b. Psoriasi s c. Tinea corporis d. Rosace a ANS: C Tinea corporis is the only listed fungal infection (noncandidal); the others are not fungal in origin. REF: p. 146 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. recurrenc e. ANS: A Unlike other skin conditions, silvery papules and plaques characterize psoriasis. REF: p. 146 Painful vesicles are associated with: a. psoriasi s. b. pityriasis rosea. c. paronychi a. d. herpes zoster. ANS: D Herpes zoster (shingles) produces painful itching or burning of the dermatome area. REF: p. 148 A 17-year-old student complains of a "rash for 3 days." You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse's next action? a. Teach infectious control measures. b. Inquire about another recent skin lesion. c. Inspect the palms and the soles. d. Inform the patient that this will resolve within a week. ANS: B The described rash is the typical presentation of pityriasis rosea. The rash is not infectious or contagious, does not involve the palms and soles, and usually lasts for several weeks. Pityriasis rosea begins with a sudden primary (herald) patch, with generalized eruption to the trunk and extremities following 1 to 3 weeks later. REF: p. 148 Which of the following is an ABCD characteristic of malignant melanoma? a. Asymmetric borders b. d. Inform the parent that this will resolve within a couple of days. ANS: A The description of this child's complaint is a varicella rash, not physical abuse or rubeola. Chickenpox is a highly communicable disease and can be prevented by immunization. The period of communicability lasts from 1 or 2 days before onset of the rash until all the vesicles have crusted over, which usually takes about 1 week. This is not physical abuse. Inspecting the buccal mucosa for Koplik spots will not diagnose the problem. This will not resolve within a couple of days. REF: p. 161 During history taking, a mother states that her son awoke in the middle of the night complaining of intense itching to his legs. Today, your inspection reveals a honey- colored exudate from the vesicular rash on his legs. Which condition is consistent with these findings? a. Exanthe m b. Impetig o c. Solar keratoses d. Trichotilloma nia ANS: B Impetigo causes intense pruritus, regional lymphadenopathy, and honey- colored exudative crusting as the vesicles or bullae rupture and dry REF: p. 160 You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was being abused? a. Recent bruising over both knees b. A healed laceration under the chin c. A bruise on the right shin with associated abrasion of tissue d. Bruises in various stages of resolution over body soft tissues ANS: D Toddlers and older children who bruise themselves accidentally do so over bony prominences, like the knees, chin, and shin. Bruises over soft tissues are more consistent with abuse. REF: p. 163 Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older adults indicates: a. sexual abuse. b. physical neglect. c. psychological abuse. d. violated rights. ANS: B Described is the most common form of elder abuse, physical neglect. REF: p. 165 The nurse assesses the nail base angle using the Schamroth technique. The normal expected examination finding is nail beds that are at the bases. a. fla t b. convex c. concav e d. bowed ANS: C The normal nail base angle should be 160 degrees, which results in a concave nail base that produces a diamond-shaped window with the Schamroth technique. REF: p. 135 A slightly elevated brownish papule with indistinct borders is a typical characteristic of a(n) nevus. ANS: compound Only a compound nevus is slightly elevated and brown, with indistinct borders. REF: p. 121 Individuals with dark pigmentary demarcation lines show lighter coloration on body surfaces. ANS: inward Individuals with pigmentary demarcation lines have darker skin on the outward-facing surfaces and lighter skin on the inward-facing surfaces. REF: p. 121 Damage into the subcutaneous tissue in a decubitus ulcer occurs at stage . 6. The largest endocrine gland in the body lies in the triangle. A. anterior B. posterior C. lateral D. medial E. ventral Upgrade to remove ads Only $1/month Thyroid 7. The cartilage is shaped like a shield, with its notch on the upper edge marking the level of bifurcation of the common carotid artery. A. cricoid B. hyoid C. thyroid D. sternocleidomastoid E. external jugular Nose and thyroid cartilages 8. Which structures disproportionately enlarge in males during adolescence? A. Coronal sutures B. Hyoid and cricoid cartilages C. Mandible and maxilla bones D. Nose and thyroid cartilages E. Mastoid processes and ears Brain growth 9. Spaces between the cranial bones accommodate A. brain growth. B. cartilage formation. C. muscular expansion. D. nerve regeneration. E. cerebrospinal fluid. Closure of the posterior fontanel 10. When examining the skull of a 4-month-old baby, you should normally find A. closure of the anterior fontanel. B. closure of the posterior fontanel. C. ossification of the all sutures. D. overlap of the cranial bones. E. closure of the sagittal and coronal sutures. 12 11. Closure of the anterior skull fontanel should occur by months. A. 3 B. 6 C. 12 D. 18 E. 24 Sternocleidomastoid 12. The thyroid gland is partially obscured by the A. cricoid cartilage. B. carotid artery. C. external jugular. D. sternocleidomastoid. E. hyoid bone. ...Chloasma 13. The brown or tan pigmentation on the forehead, nose, and malar prominence of some pregnant women is called A. hormonal acne. B. erythema. C. alopecia. D. chloasma. E. craniotabes. A bruit may be auscultated. 14. Which of the following is an expected change in the assessment of the thyroid during pregnancy? A. Palpation of the gland becomes difficult. B. A bruit may be auscultated. C. Inspection reveals a goiter. D. The gland is tender on palpation. E. The gland feels fibrotic. Hyperthyroidism 15. A bruit heard over the thyroid is suggestive of A. hypothyroidism. B. hyperthyroidism. C. thyroid cancer. D. thyroid cyst. E. thyroid nodule. Current medications 16. Ms. G is a 22-year-old secretary who comes to the clinic with headaches of 6 weeks' duration. She tells the office assistant about her heavy schedule, including part-time work and evening classes. Her vital signs are normal. Which information is most appropriate to Ms. G's history? A. Current medications B. Elimination patterns C. Immunization status D. Previous pregnancies E. Previous abdominal surgeries Head position 17. Observation during history taking is the best way to examine for A. head position. B. scalp lice. C. thyroid size. D. tracheal alignment. E. thickening of the temporal arteries. The presence of torticollis 18. During a head and neck assessment of a neonate, it is important to screen for A. the presence of torticollis. B. signs and symptoms of cerebral palsy. C. uneven movement of the eyes. D. unilateral movement of the tongue. E. the absence of fine motor skills. Upgrade to remove ads Only $1/month Record the finding in the patient's chart 19. During physical examination of a 30-year-old Chinese man, you notice a slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to A. ask the patient if this characteristic runs in his family. B. perform monofilament testing on the face. C. obtain a complete blood analysis. D. record the finding in the patient's chart. E. obtain a CT scan of the head. Facial nerve paralysis may be present 20. What is the significance of a patient with asymmetry of the entire side of the face? A. A degenerative process may be developing. B. A peripheral trigeminal nerve problem exists. C. Asymmetry of body sides is a normal finding. D. Visual and hearing problems will be present. E. Facial nerve paralysis may be present. a vascular anomaly 21. A bruit, or blowing sound, over the skull or temporal region of an adult indicates A. degenerative change. B. hyperthyroid storm. C. a skull fracture. D. a vascular anomaly. E. Cushing syndrome. tics 22. Spasmodic muscular contractions of the head, face, or neck are called A. torticollis. B. tics. C. dimpling. D. webbing. E. chloasma. Hypothyroidism 23. Coarse, dry, and brittle hair is associated with which metabolic disorder? A. Hypothyroidism B. Diabetes mellitus C. Addison disease D. Cushing syndrome E. Fetal alcohol syndrome Sagittal suture ridge D. Hypertensive E. Cluster Whether she is particularly stressed or overworked 37. A 29-year-old woman presents to the urgent care center with a history of a severe headache of 2 hours' duration. She describes it as bandlike and constricting. In interviewing the woman about her complaint, you would ask A. whether she has experienced increased tearfulness. B. the date of her last menstrual period. C. whether these headaches started in childhood. D. whether she is particularly stressed or overworked. E. whether she is missing meals. Thyroglossal duct cyst 38. RJ presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely: A. torticollis. B. branchial cleft cyst. C. Stensen duct stone. D. thyroglossal duct cyst. E. parotid gland tumor. Graves disease 39. Moist skin with fine hair, prominent eyes, eyelid retraction, and a staring expression are characteristics associated with A. Cushing syndrome. B. Graves disease. C. myxedema. D. systemic lupus erythematosus. E. Hippocratic facies. Terminal illness 40. You are examining Ms. L, age 78 years. You find a sunken appearance of her eyes, cheeks, and temporal areas. Her skin is dry, and her nose appears sharp. Ms. L's facies description is associated with A. cutis laxa syndrome. B. Hurler syndrome. C. old age. D. terminal illness. E. myxedema. Mild ptosis 41. Which of the following findings would be consistent with fetal alcohol syndrome? A. Corneal clouding B. Eye slanting C. Mild ptosis D. Symmetric bulging fontanels E. Maxillary hypoplasia Thyroglossal duct cyst 42. What abnormal palpable cystic mass in the neck rises from the foramen cecum at the junction of the anterior two thirds and posterior third of the tongue? A. Branchial cleft cyst B. Thyroglossal duct cyst C. Lacrimal duct D. Submandibular lymph node E. Stensen duct Upgrade to remove ads Only $1/month Hashimoto disease 43. Which of the following is a chronic autoimmune disorder? A. Microcephaly B. Hashimoto disease C. Salivary gland tumor D. Down syndrome E. Hurler syndrome Craniosynostosis 44. The premature union of cranial sutures that involves the shape of the head without mental retardation is A. craniosynostosis. B. encephalocele. C. microcephaly. D. myxedema. E. fetal alcohol syndrome. 4.7 45. What is the positive likelihood ratio that a patient with conjunctival pallor has anemia? A. 3.8 B. 4.7 C. 6.1 D. None of the above Hypocalcemia 46. A Chvostek sign is indicative of A. hypothyroidism B. hypoparathyriodism C. hypocalcemia D. hypogonadism E. lymphoma Hyperthyroidism 47. A patient with carotid artery prominence would most likely have A. hyperthyroidism B. hyperparathyroidism C. meningeal irritation D. COPD Congestive heart failure 48. Jugular venous distension is related to A. hypertension B. hyperthyroidism C. congestive heart failure D. anemia E. COPD Atelectasis 49. A patient presenting with tracheal deviation most likely has A. chronic bronchitis B. left sided heart failure C. consolidation of the lung D. atelectasis E. COPD 1700 You are using the "rule of thumb" for advising a 150-pound person regarding the appropriate number of calories to promote weight loss. Your advice is for the person to consume no more than calories Vitamin B12 Deficiency of which of the following is a concern in the vegetarian diet? 30 When using "rule of thumb" estimates of energy needs of healthy adults, how many kcal/kg are required to maintain the individual's current weight? Infants and children up to 2 years of age Which age group requires the highest percentage of dietary fat intake? 20 to 35 Adult recommended dietary fat intake is g per day. 20 To obtain essential fatty acids, an intake of at least g per day of fat is recommended. fiber In children 3 to 18 years of age, the formula "age + 5 g" should be used to determine needs. Steroids Which medication is frequently associated with weight gain? a first-degree relative with an eating disorder. A major risk factor for developing an eating disorder is having: [(Weight in pounds 703) ÷ height in inches] ÷ height in inches Body mass index (BMI) is calculated by which of the following? cardiovascular disease risk. Monitoring a patient's waist-to-hip ratio provides data concerning: Upgrade to remove ads Only $1/month binges and vomits A 17-year-old girl presents to the clinic for a sport's physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: Patients become malnourished. a. more nasal stuffiness During which developmental stage are hoarseness, voice cracking, and a persistent cough common findings in females? a.Adolescence b. Infancy c. Menopause d. Pregnancy d. Pregnancy Hearing tends to decline after 50 years of age because of deterioration of: a. hair cells of the organ of Corti. b. the eustachian tube. c. the helix. d. cerumen. a. hair cells of the organ of Corti You are performing hearing screening tests. Who would be expected to find difficulty in hearing the highest frequencies? a.A 7-year-old b.An 18-year-old c.A 30-year-old d.A 50-year-old d. A 50-year-old Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss? a. Chlorothiazide b.Acetaminophen c. Salicylates d. Cephalosporins c. Salicylates Mr. Williams, age 25 years, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history? a.Age-specific data b. Past medical data c. Past surgical data d. Social history b. Past medical data A 6-month-old who can hear well can be expected to: a. exhibit the Moro reflex. b. stop breathing in response to sudden noise. c. turn his or her head toward the source of sound. d. imitate simple words. c. turn his or her head toward the source of sound Which risk factor is associated with the highest rate of oral cancers? a. Women b. Being younger than 55 years c. excessive caffeine use d. Fanconi anemia d. Fanconi anemia To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz c. 500 to 1000 Hz You are using a pneumatic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. change to a larger speculum. c. squeeze the bulb with more force. d. insert the speculum to a depth of 2 cm. b. change to a larger speculum An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorders. b. skeletal anomalies. c. renal disorders. d. heart defects. c. renal disorders Normal tympanic membrane color is: a. amber. b. chalky white. c. green. d. pearly gray. d. pearly gray. Bulging of an amber tympanic membrane without mobility is usually associated with: a. middle ear effusion. b. healed tympanic membrane perforation. c. impacted cerumen in the canal. d. repeated and prolonged crying cycles. a. middle ear effusion. Severe vertigo, tinnitus, and progressive hearing loss are characteristic of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. b. Ménière disease When hearing is evaluated, which cranial nerve is being tested? a. III b. IV c. VIII d. XII c. VIII Speech with a monotonous tone and erratic volume may indicate: a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. b. hearing loss 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. lateralization of sound. d. mallear auditory ability. c. lateralization of sound To perform the Rinne test, place the tuning fork on the: a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. b. mastoid bone You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, air conduction-to- bone conduction ratio is less than 2:1. You interpret these findings as suggestive of: a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen. a. a defect in the inner ear. Nasal symptoms that imply an allergic response include: a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal membranes. d. firm consistency of turbinates. b. bluish gray turbinates You are interviewing a parent whose child has a fever, is pulling at her right ear, and is irritable. You ask the parent about the child's appetite and find that the child has a decreased appetite. This additional finding is more suggestive of: a. acute otitis media. b. otitis externa. c. serous otitis media. d. middle ear effusion. a. acute otitis media. A smooth red tongue with a slick appearance may indicate: a. niacin or vitamin B12 deficiency. Direct questioning about domestic violence in the home should be: The presence of domestic violence should be routinely queried, and the questioning should be direct for all female patients. Behaviors that diffuse anxiety during the interview include: To relieve anxiety, the health professional should answer patient questions forthrightly, avoiding overload of information and without hurrying the conversation. In issues surrounding ethical decision making, beneficence refers to the: 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. An example of a complementary care modality is: Complementary care includes acupuncture, aromatherapy, therapeutic touch, and herbal medications. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to: With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. Which of the following is not a characteristic of the plan portion of the problem-oriented medical record? Develop a plan for each problem on the problem list. A differential diagnosis is part of the assessment phase. Diagnostics ordered, therapeutics, and patient education are all part of the plan related to the diagnosis given. The review of systems is a component of the: Review of systems relates health history according to physical systems and is related just before the actual physical examination. A brief statement of the reason the patient is seeking health care is called the: The chief complaint is a brief statement of the reason the patient is seeking health care. Allergies to drugs and foods are generally listed in which section of the medical record? The past medical history section contains information such as drugs, foods, and environmental allergies. Ms. S. reports that she is concerned about her loss of appetite. During the history, you learn that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S. s loss of appetite, it would be better to: It is best to document what you observe and what is said by the patient rather than document your interpretations. Listening and quoting exactly what the patient says is the better rule to follow; there is no indication that you should refer her or clarif When recording physical findings, which data are recorded first for all systems? What finding is unique to the documentation of a physical examination of an infant? The size and characteristic of the fontanel are unique and important in the assessment of an infant. Data on liver span, prostate size, thyroid position, and visual acuity are adult assessment findings. Constitutional symptoms in the ROS refer to: General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change). A survey of mobility and activities of daily living (ADLs) is part of a(n): A functional assessment is an assessment of a patient s mobility, upper extremity movement, household management, ADLs, and instrumental activities of daily living (IADLs). Subjective and symptomatic data are: 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.