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Chapter 1
MULTIPLE CHOICE
1. For which of the following patients would a comprehensive health history be appropriate?
A) A new patient with the chief complaint of ―I sprained my ankle‖
B) An established patient with the chief complaint of ―I have an upper respiratory infection‖
C) A new patient with the chief complaint of ―I am here to establish care‖
D) A new patient with the chief complaint of ―I cut my hand‖
Ans: C
Chapter: 01
Page and Header: 4, Patient Assessment: Comprehensive or Focused
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive
health history is appropriate.
2. The components of the health history include all of the following except which one?
A) Review of systems
B) Thorax and lungs
C) Present illness
D) Personal and social items
Ans: B
Chapter: 01
Feedback: The thorax and lungs are part of the physical examination, not part of the health
history. The others answers are all part of a complete health history.
3. Is the following information subjective or objective?
Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity
and relieved by rest.
A) Subjective
B) Objective
Ans: A
Chapter: 01
4. Is the following information subjective or objective?
Mr. M. has a respiratory rate of 32 and a pulse rate of 120.
A) Subjective
B) Objective
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Ans:
B
Ans: A
Chapter:
01
Chapter: 01
Feedback:
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is information
a measurement
obtained
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5. The following information is recorded in the health history: ―The patient has had abdominal
pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9
on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the midepigastric area.‖
Which of these categories does it belong to?
A) Chief complaint
B) Present illness
C) Personal and social history
D) Review of systems
Ans: B
Chapter: 01
Feedback: This information describes the problem of abdominal pain, which is the present
illness. The interviewer has obtained the location, timing, severity, and associated manifestations
of the pain. The interviewer will still need to obtain information concerning the quality of the
pain, the setting in which it occurred, and the factors that aggravate and alleviate the pain. You
will notice that it does include portions of the pertinent review of systems, but because it relates
directly to the complaint, it is included in the history of present illness.
6. The following information is recorded in the health history: ―The patient completed 8th grade.
He currently lives with his wife and two children. He works on old cars on the weekend. He
works in a glass factory during the week.‖
Ans: C
Chapter: 01
Feedback: Personal and social history information includes educational level, family of origin,
current household status, personal interests, employment, religious beliefs, military history, and
lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual
preferences and history). All of this information is documented in this example.
7. The following information is recorded in the health history: ―I feel really tired.‖
Which category does it belong to?
A) Chief complaint
B) Present illness
C) Personal and social history
D) Review of systems
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Ans: A
Chapter:
Ans: A 01
Chapter: 01
Feedback: The chief complaint is an attempt to quote the patient's own words, as long as they
are
suitableThis
to print.
It is brief, like
a headline,
andhospitalization
further details should
be sought
in the
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for an asthma exacerbation, you may consider
8. The following information is recorded in the health history: ―Patient denies chest pain,
palpitations, orthopnea, and paroxysmal nocturnal dyspnea.‖
Which category does it belong to?
A) Chief complaint
B) Present illness
C) Personal and social history
D) Review of systems
Ans: D
Chapter: 01
Feedback: Review of systems documents the presence or absence of common symptoms related
9. The following information is best placed in which category?
―The patient has had three cesarean sections.‖
A) Adult illnesses
B) Surgeries
C) Obstetrics/gynecology
D) Psychiatric
Ans: B
Chapter: 01
Feedback: A cesarean section is a surgical procedure. Approximate dates or the age of the patient
at the time of the surgery should also be recorded.
10. The following information is best placed in which category?
―The patient had a stent placed in the left anterior descending artery (LAD) in 1999.‖
A) Adult illnesses
B) Surgeries
C) Obstetrics/gynecology
D) Psychiatric
Ans: A
Chapter: 01
Feedback: The adult illnesses category is reserved for chronic illnesses, significant
hospitalizations, significant injuries, and significant procedures. A stent is a major procedure but
does not involve a surgeon.
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Ans: A
11. The following information is best placed in which category?
Chapter: 01
―The patient was treated for an asthma exacerbation in the hospital last year; the patient has
never been intubated.‖
Feedback: This is information about a significant hospitalization and should be placed in the
A) Adult illnesses
adult illnesses section. If the patient is being seen for an asthma exacerbation, you may consider
B) Surgeries
C) Obstetrics/gynecology
D) Psychiatric
placing this information in the present illness section, because it relates to the chief complaint at
that visit.
Chapter 2 Critical Thinking in Health Assessment
MULTIPLE CHOICE
1. When performing a physical assessment, the first technique the nurse will always use is:
a. Palpation.
b. Inspection.
c. Percussion.
d. Auscultation.
ANS: B
The skills requisite for the physical examination are inspection, palpation, percussion, and
auscultation. The skills are performed one at a time and in this order (with the exception of the
abdominal assessment, during which auscultation takes place before palpation and percussion).
The assessment of each body system begins with inspection. A focused inspection takes time and
yields a surprising amount of information.
2. The nurse is preparing to perform a physical assessment. Which statement is true about the
physical assessment? The inspection phase:
a. Usually yields little information.
b. Takes time and reveals a surprising amount of information.
c. May be somewhat uncomfortable for the expert practitioner.
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a. Turgor
b. Texture
c. Density
A focused inspection takes time and yields a surprising amount of information. Initially, the
examiner may feel uncomfortable, staring at the person without also doing something. A focused
assessment is significantly more than a quick glance.
3. The nurse is assessing a patients skin during an office visit. What part of the hand and
technique should be used to best assess the patients skin temperature?
a. Fingertips; they are more sensitive to small changes in temperature.
b. Dorsal surface of the hand; the skin is thinner on this surface than on the palms.
c. Ulnar portion of the hand; increased blood supply in this area enhances
temperature sensitivity.
d. Palmar surface of the hand; this surface is the most sensitive to temperature
variations because of its increased nerve supply in this area.
ANS: B
The dorsa (backs) of the hands and fingers are best for determining temperature because the skin
is thinner on the dorsal surfaces than on the palms. Fingertips are best for fine, tactile
discrimination. The other responses are not useful for palpation.
4. Which of these techniques uses the sense of touch to assess texture, temperature, moisture, and
swelling when the nurse is assessing a patient?
a. Palpation
b. Inspection
c. Percussion
d. Auscultation
ANS: A
5. The nurse is preparing to assess a patients abdomen by palpation. How should the nurse
proceed?
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a. Turgor
b. Texture
c. Density
a. Palpation of reportedly tender areas are avoided because palpation in these areas
may cause pain.
b. Palpating a tender area is quickly performed to avoid any discomfort that the
patient may experience.
c. The assessment begins with deep palpation, while encouraging the patient to relax
and to take deep breaths.
d. The assessment begins with light palpation to detect surface characteristics and to
accustom the patient to being touched.
ANS: D
Light palpation is initially performed to detect any surface characteristics and to accustom the
person to being touched. Tender areas should be palpated last, not first.
6. The nurse would use bimanual palpation technique in which situation?
a. Palpating the thorax of an infant
b. Palpating the kidneys and uterus
c. Assessing pulsations and vibrations
d. Assessing the presence of tenderness and pain
ANS: B
Bimanual palpation requires the use of both hands to envelop or capture certain body parts or
organs such as the kidneys, uterus, or adnexa. The other situations are not appropriate for
bimanual palpation.
7. The nurse is preparing to percuss the abdomen of a patient. The purpose of the percussion is to
assess the
of the underlying tissue.
d. Consistency
ANS: C
Percussion yields a sound that depicts the location, size, and density of the underlying organ.
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a. Turgor
b. Texture
c. Density
Turgor and texture are assessed with palpation.
8. The nurse is reviewing percussion techniques with a newly graduated nurse. Which technique,
if used by the new nurse, indicates that more review is needed?
a. Percussing once over each area
b. Quickly lifting the striking finger after each stroke
c. Striking with the fingertip, not the finger pad
d. Using the wrist to make the strikes, not the arm
ANS: A
For percussion, the nurse should percuss two times over each location. The striking finger should
be quickly lifted because a resting finger damps off vibrations. The tip of the striking finger
should make contact, not the pad of the finger. The wrist must be relaxed and is used to make the
strikes, not the arm.
9. When percussing over the liver of a patient, the nurse notices a dull sound. The nurse should:
a. Consider this a normal finding.
b. Palpate this area for an underlying mass.
c. Reposition the hands, and attempt to percuss in this area again.
d. Consider this finding as abnormal, and refer the patient for additional treatment.
ANS: A
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Percussion over relatively dense organs, such as the liver or spleen, will produce a dull sound.
The other responses are not correct.
10. The nurse is unable to identify any changes in sound when percussing over the abdomen of
an obese patient. What should the nurse do next?
a. Ask the patient to take deep breaths to relax the abdominal musculature.
b. Consider this finding as normal, and proceed with the abdominal assessment.
c. Increase the amount of strength used when attempting to percuss over the
abdomen.
d. Decrease the amount of strength used when attempting to percuss over the
abdomen.
ANS: C
The thickness of the persons body wall will be a factor. The nurse needs a stronger percussion
stroke for persons with obese or very muscular body walls. The force of the blow determines the
loudness of the note. The other actions are not correct.
11. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4year-old child. The nurse should:
a. Palpate over the area for increased pain and tenderness.
b. Ask the child to take shallow breaths, and percuss over the area again.
c. Immediately refer the child because of an increased amount of air in the lungs.
d. Consider this finding as normal for a child this age, and proceed with the
examination.
ANS: D
Percussion notes that are loud in amplitude, low in pitch, of a booming quality, and long in
duration are normal over a childs lung.
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12. A patient has suddenly developed shortness of breath and appears to be in significant
respiratory distress. After calling the physician and placing the patient on oxygen, which of these
actions is the best for the nurse to take when further assessing the patient?
a. Count the patients respirations.
b. Bilaterally percuss the thorax, noting any differences in percussion tones.
c. Call for a chest x-ray study, and wait for the results before beginning an
assessment.
d. Inspect the thorax for any new masses and bleeding associated with respirations.
ANS: B
Percussion is always available, portable, and offers instant feedback regarding changes in
underlying tissue density, which may yield clues of the patients physical status.
13. The nurse is teaching a class on basic assessment skills. Which of these statements is true
regarding the stethoscope and its use?
a. Slope of the earpieces should point posteriorly (toward the occiput).
b. Although the stethoscope does not magnify sound, it does block out extraneous
room noise.
c. Fit and quality of the stethoscope are not as important as its ability to magnify
sound.
d. Ideal tubing length should be 22 inches to dampen the distortion of sound.
ANS: B
The stethoscope does not magnify sound, but it does block out extraneous room sounds. The
slope of the earpieces should point forward toward the examiners nose. Long tubing will distort
sound. The fit and quality of the stethoscope are both important.
14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true
regarding the diaphragm of the stethoscope? The diaphragm:
a. Is used to listen for high-pitched sounds.
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b. Is used to listen for low-pitched sounds.
c. Should be lightly held against the persons skin to block out low-pitched sounds.
d. Should be lightly held against the persons skin to listen for extra heart sounds and
murmurs.
ANS: A
The diaphragm of the stethoscope is best for listening to high-pitched sounds such as breath,
bowel, and normal heart sounds. It should be firmly held against the persons skin, firmly enough
to leave a ring. The bell of the stethoscope is best for soft, low-pitched sounds such as extra heart
sounds or murmurs.
15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse
should:
a. Warm the endpiece of the stethoscope by placing it in warm water.
b. Leave the gown on the patient to ensure that he or she does not get chilled during
the examination.
c. Ensure that the bell side of the stethoscope is turned to the on position.
d. Check the temperature of the room, and offer blankets to the patient if he or she
feels cold.
ANS: D
The examination room should be warm. If the patient shivers, then the involuntary muscle
contractions can make it difficult to hear the underlying sounds. The end of the stethoscope
should be warmed between the examiners hands, not with water. The nurse should never listen
through a gown. The diaphragm of the stethoscope should be used to auscultate for bowel
sounds.
16. The nurse will use which technique of assessment to determine the presence of crepitus,
swelling, and pulsations?
a. Palpation
b. Inspection
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c. Percussion
d. Auscultation
ANS: A
Palpation applies the sense of touch to assess texture, temperature, moisture, organ location and
size, as well as any swelling, vibration or pulsation, rigidity or spasticity,
17. The nurse is preparing to use an otoscope for an examination. Which statement is true
regarding the otoscope? The otoscope:
a. Is often used to direct light onto the sinuses.
b. Uses a short, broad speculum to help visualize the ear.
c. Is used to examine the structures of the internal ear.
d. Directs light into the ear canal and onto the tympanic membrane.
ANS: D
The otoscope directs light into the ear canal and onto the tympanic membrane that divides the
external and middle ear. A short, broad speculum is used to visualize the nares.
18. An examiner is using an ophthalmoscope to examine a patients eyes. The patient has
astigmatism and is nearsighted. The use of which of these techniques would indicate that the
examination is being correctly performed?
a. Using the large full circle of light when assessing pupils that are not dilated
b. Rotating the lens selector dial to the black numbers to compensate for
astigmatism
c. Using the grid on the lens aperture dial to visualize the external structures of the
eye
d. Rotating the lens selector dial to bring the object into focus
ANS: D
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The ophthalmoscope is used to examine the internal eye structures. It can compensate for
nearsightedness or farsightedness, but it will not correct for astigmatism. The grid is used to
assess size and location of lesions on the fundus. The large full spot of light is used to assess
dilated pupils. Rotating the lens selector dial brings the object into focus.
19. The nurse is unable to palpate the right radial pulse on a patient. The best action would be to:
a. Auscultate over the area with a fetoscope.
b. Use a goniometer to measure the pulsations.
c. Use a Doppler device to check for pulsations over the area.
d. Check for the presence of pulsations with a stethoscope.
ANS: C
Doppler devices are used to augment pulse or blood pressure measurements. Goniometers
measure joint range of motion. A fetoscope is used to auscultate fetal heart tones. Stethoscopes
are used to auscultate breath, bowel, and heart sounds.
20. The nurse is preparing to perform a physical assessment. The correct action by the nurse is
reflected by which statement? The nurse:
a. Performs the examination from the left side of the bed.
b. Examines tender or painful areas first to help relieve the patients anxiety.
c. Follows the same examination sequence, regardless of the patients age or
condition.
d. Organizes the assessment to ensure that the patient does not change positions too
often.
ANS: D
The steps of the assessment should be organized to ensure that the patient does not change
positions too often. The sequence of the steps of the assessment may differ, depending on the age
of the person and the examiners preference. Tender or painful areas should be assessed last.
Chapter 3 Interviewing and Communication
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Multiple Choice
1. You are running late after your quarterly quality improvement meeting at the hospital and
have just gotten paged from the nurses' station because a family member of one of your patients
wants to talk with you about that patient's care. You have clinic this afternoon and are doublebooked for the first appointment time; three other patients also have arrived and are sitting in the
waiting room. Which of the following demeanors is a behavior consistent with skilled
interviewing when you walk into the examination room to speak with your first clinic patient?
A) Irritability
B) Impatience
C) Boredom
D) Calm
Ans: D
Chapter: 03
Feedback: The appearance of calmness and patience, even when time is limited, is the hallmark
of a skilled interviewer.
2. Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing
to go into the examination room to interview her. Which of the following is the most logical
sequence for the patient–provider interview?
A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story.
B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport.
C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and
clarify the patient's story, and negotiate a plan.
D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.
Ans: C
Chapter: 03
Feedback: This is the most productive sequence for the interview. Greeting patients and
establishing rapport allows them to feel more comfortable before ―inviting‖ them to relate their
story. After hearing the patient's story, together you establish the agenda regarding the most
important items to expand upon. At the end, together you negotiate the plan of diagnosis and
treatment.
3. Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is
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a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the
worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and
it seems to be worse a couple of hours after eating. She has noticed that it starts after eating
greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week,
but now it is occurring every other day. Nothing makes it better. From this description, which of
the seven attributes of a symptom has been omitted?
A) Setting in which the symptom occurs
B) Associated manifestations
C) Quality
D) Timing
Ans: B
Chapter: 03
Feedback: The interviewer has not recorded whether or not the pain has been accompanied by
nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional
symptoms that may accompany the initial chief complaint and that help the examiner to start
refining his or her differential diagnosis.
4. Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of
breath. The shortness of breath occurs with exertion and improves with rest. It has been going on
for several months and initially occurred only a couple of times a day with strenuous exertion;
however, it has started to occur with minimal exertion and is happening more than a dozen times
per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest
pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal
dyspnea.
Which of the following symptom attributes was not addressed in this description?
A) Severity
B) Setting in which the symptom occurs
C) Timing
D) Associated manifestations
Ans: A
Chapter: 03
Feedback: The severity of the symptom was not recorded by the interviewer, so we have no
understanding as to how bad the symptom is for this patient. The patient could have been asked
to rate his pain on a 0 to 10 scale or used one of the other standardized pain scales available.
This allows the comparison of pain intensity before and after an intervention.
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a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the
worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and
it seems to be worse a couple of hours after eating. She has noticed that it starts after eating
greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week,
but now it is occurring every other day. Nothing makes it better. From this description, which of
B) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to
worry about it being a sign of cancer
C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms
that she is experiencing
D) Asking her to tell you exactly what she means when she states that she has a urinary tract
infection
Ans: B
Chapter: 03
Feedback: Reassurance is not part of clarifying the patient's story; it is part of establishing
rapport and empathizing with the patient.
6. Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be
checked out for the symptom of chest pain. As you listen to him describe his symptom in more
detail, you say ―Go on,‖ and later, ―Mm-hmmm.‖ This is an example of which of the following
skilled interviewing techniques?
A) Echoing
B) Nonverbal communication
C) Facilitation
D) Empathic response
Ans: C
Chapter: 03
Feedback: This is an example of facilitation. Facilitation can be posture, actions, or words that
encourage the patient to say more.
7. Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her
daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and
doesn't say anything in response to your question. This is an example of which type of
challenging patient?
A) Talkative patient
B) Angry patient
C) Silent patient
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D) Hearing-impaired patient
Ans: C
Chapter: 03
Feedback: This is one example of a silent patient. There are many possibilities for this patient's
silence: depression, dementia, the manner in which you asked the question, and so on.
8. Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular
provider is on vacation and she wanted to be seen. You have heard about her many times from
your colleague and are aware that she is a very talkative person. Which of the following is a
helpful technique to improve the quality of the interview for both the provider and the patient?
A) Allow the patient to speak uninterrupted for the duration of the appointment.
B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have
her focus on one aspect of what she told you.
C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in
the course of the interview.
D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the
appointment needs to end.
Ans: B
Chapter: 03
Feedback: You can also say, ―I want to make sure I take good care of this problem because it is
very important. We may need to talk about the others at the next appointment. Is that okay with
you?‖ This is a technique that can help you to change the subject but, at the same time, validate
the patient's concerns; it also can provide more structure to the interview.
9. Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the
room, she appears to be very angry. She has a raised tone of voice and states that she has been
waiting for the past hour and has to get back to work. She states that she is unimpressed by the
reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't
call in an antibiotic for her. Which of the following techniques is not useful in helping to calm
this patient?
A) Avoiding admission that you had a part in provoking her anger because you were late
B) Accepting angry feelings from the patient and trying not to get angry in return
C) Staying calm
D) Keeping your posture relaxed
Ans: A
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Chapter: 03
Feedback: In this scenario, the provider was 1 hour late in seeing the patient. The provider
should acknowledge that he was late and apologize for this, no matter the reason for being late.
It often helps to acknowledge that a patient's anger with you is understandable and that you
might be angry in a similar situation.
10. A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge.
As the provider, you need to get a sexual history. Which one of the following questions is
inappropriate for eliciting the information?
A) Are you sexually active?
B) When was the last time you had intimate physical contact with someone, and did that contact
include sexual intercourse?
C) Do you have sex with men, women, or both?
D) How many sexual partners have you had in the last 6 months?
Ans: A
Chapter: 03
Feedback: This is inappropriate because it is too vague. Given the complaint, you should
probably assume that he is sexually active. Sometimes patients may respond to this question with
the phrase ―No, I just lie there.‖ A specific sexual history will help you to assess this patient's
risk for other sexually transmitted infections.
11. Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has
come to the office many times in the past with a variety of injuries, and you suspect that he has a
problem with alcohol. Which one of the following questions will be most helpful in diagnosing
this problem?
A) You are an alcoholic, aren't you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
Ans: B
Chapter: 03
Feedback: This is a good opening question that is general and neutral in tone; depending on the
timing, you will be able to ask for more specific information related to the patient's last drink.
The others will tend to stifle the conversation because they are closed-ended questions. Answer
D implies negative behavior and may also keep the person from sharing freely with you.
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12. On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual
visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side
effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her
script, she mentions that it is hard not having her husband Bill around anymore. What would you
do next?
A) Hand her the script and make sure she has a 3-month follow-up appointment.
B) Make sure she understands the script.
C) Ask why Bill is not there.
D) Explain that you will have more time at the next visit to discuss this.
Ans: C
Chapter: 03
Feedback: Sometimes, the patient's greatest need is for support and empathy. It would be
inappropriate to ignore this comment today. She may have relied heavily upon Bill for care and
may be in danger. She may be depressed and even suicidal, but you will not know unless you
discuss this with her. Most importantly, you should empathize with her by saying something like
―It must be very difficult not to have him at home‖ and allow a pause for her to answer. You
may also ask ―What did you rely on him to do for you?‖ Only a life-threatening crisis with
another patient should take you out of her room at this point, and you may need to adjust your
office schedule to allow adequate time for her today.
13. A patient is describing a very personal part of her history very quickly and in great detail.
How should you react to this?
A) Write down as much as you can, as quickly as possible.
B) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost every
word.
C) Tell her that she can go over the notes later to make sure they are accurate.
D) Push away from the keyboard or put down your pen and listen.
Ans: D
Chapter: 03
Feedback: This is a common event in clinical practice. It is much more important to listen
actively with good eye contact at this time than to document the story verbatim. You want to
minimize interruption (e.g., answer B). It is usually not appropriate to ask a patient to go over
the written notes, but it would be a good idea to repeat the main ideas back to her. You should be
certain she has completed her story before doing this. By putting down your pen or pushing
away from the keyboard, you let the patient know that her story is the most important thing to
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you at this moment.
14. You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire
right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the
last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by
a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next?
A) Carry out your examination, focusing on the neurologic portion, and then cover her properly.
B) Carry out your examination and let the nurse assigned to her ―put her back together.‖
C) Put her socks back on and cover her completely before beginning the evaluation.
D) Apologize for the last examiner but let the next examiner dress and cover her.
Ans: C
Chapter: 03
Feedback: It is crucial to make an effort to make a patient comfortable. In this scenario, the
patient can neither speak nor move well. Take a moment to imagine yourself in her situation.
As a matter of respect as well as comfort, you should cover the patient appropriately and
consider returning a little later to do your examination if you feel she is cold. While it is her
nurse's job to keep her comfortable, it is also your responsibility, and you should do what you
can. It is unacceptable to leave the patient in the same state in which you found her.
15. When you enter your patient's examination room, his wife is waiting there with him. Which
of the following is most appropriate?
A) Ask if it's okay to carry out the visit with both people in the room.
B) Carry on as you would ordinarily. The permission is implied because his wife is in the room
with him.
C) Ask his wife to leave the room for reasons of confidentiality.
D) First ask his wife what she thinks is going on.
Ans: A
Chapter: 03
Feedback: Even in situations involving people very familiar with each other, it is important to
respect individual privacy. There is no implicit consent merely because he has allowed his wife
to be in the room with him. On the other hand, it is inappropriate to assume that his wife should
leave the room. Remember, the patient is the focus of the visit, so it would be appropriate to
allow him to control who is in the room with him and inappropriate to address his wife first.
Although your duty is to the patient, you may get optimal information by offering to speak to
both people confidentially. This situation is analogous to an adolescent's visit.
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16. A patient complains of knee pain on your arrival in the room. What should your first
sentence be after greeting the patient?
A) How much pain are you having?
B) Have you injured this knee in the past?
C) When did this first occur?
D) Could you please describe what happened?
Ans: D
Chapter: 03
Feedback: When looking into a complaint, it is best to start with an invitation for the patient to
tell you in his or her own words. More specific questions should be used later in the interview to
fill in any gaps.
17. You have just asked a patient how he feels about his emphysema. He becomes silent, folds
his arms across his chest and leans back in his chair, and then replies, ―It is what it is.‖ How
should you respond?
A) ―You seem bothered by this question.‖
B) ―Next, I would like to talk with you about your smoking habit.‖
C) ―Okay, let's move on to your other problems.‖
D) ―You have adopted a practical attitude toward your problem.‖
Ans: A
Chapter: 03
Feedback: You have astutely noted that the patient's body language changed at the time you
asked this question, and despite the patient's response, you suspect there is more beneath the
surface. Maybe he is afraid of being browbeaten about his smoking, maybe a relative has
recently died from this disorder, or maybe a friend told him 20 years ago that he would
eventually get emphysema. Regardless, by sharing your observation and leaving a pause, he
may begin to talk about some issues which are very important to him.
18. A patient tells you about her experience with prolonged therapy for her breast cancer. You
comment, ―That must have been a very trying time for you.‖ What is this an example of?
A) Reassurance
B) Empathy
C) Summarization
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D) Validation
Ans: D
Chapter: 03
Feedback: This is an example of validation to legitimize her emotional experience. ―Now that
you have had your treatment, you should not have any further troubles‖ is an example of
reassurance. ―I understand what you went through because I am a cancer survivor myself‖ is an
example of empathy. ―So, you have had a lumpectomy and multiple radiation treatments‖ is an
example of summarization as applied to this vignette.
19. You are performing a young woman's first pelvic examination. You make sure to tell her
verbally what is coming next and what to expect. Then you carry out each maneuver of the
examination. You let her know at the outset that if she needs a break or wants to stop, this is
possible. You ask several times during the examination, ―How are you doing, Brittney?‖ What
are you accomplishing with these techniques?
A) Increasing the patient's sense of control
B) Increasing the patient's trust in you as a caregiver
C) Decreasing her sense of vulnerability
D) All of the above
Ans: D
Chapter: 03
Feedback: These techniques minimize the effects of transitions during an examination and
empower the patient. Especially during a sensitive examination, it is important to give the
patient as much control as possible.
20. When using an interpreter to facilitate an interview, where should the interpreter be
positioned?
A) Behind you, the examiner, so that the lips of the patient and the patient's nonverbal cues can
be seen
B) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues
of the patient
C) Between you and the patient so all parties can make the necessary observations
D) In a corner of the room so as to provide minimal distraction to the interview
Ans: B
Feedback: Interpreters are invaluable in encounters where the examiner and patient do not speak
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the same language, including encounters with the deaf. It should be noted that deaf people from
different regions of the world use different sign languages. The priority is for you to have a good
view of the patient. Remember to use short, simple phrases while speaking directly to the patient
and ask the patient to repeat back what he or she understands.
Chapter 4 The Health History
Multiple Choice
1. A 15-year-old high school sophomore and her mother come to your clinic because the mother
is concerned about her daughter's weight. You measure her daughter's height and weight and
obtain a BMI of 19.5 kg/m2 . Based on this information, which of the following is appropriate?
A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in her diet because
she is obese.
Ans: B
Chapter: 04
Feedback: The patient has a normal BMI; the range for a normal BMI is 18.5 to 24.9 kg/m 2 .
You may be able to give the patient and her mother the lower limit of normal in pounds for her
daughter's height, or instruct her in how to use a BMI table.
2. A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is
26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate
counsel for the patient during the visit?
A) Refer the patient to a nutritionist because he is anorexic.
B) Reassure the patient that he has a normal body weight.
C) Give the patient information about reduction of fat, cholesterol, and calories because he is
overweight.
D) Give the patient information about reduction of fat and cholesterol because he is obese.
Ans: C
Chapter: 04
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Feedback: The patient has a BMI in the overweight range, which is 25.0 to 29.9 kg/m 2 . It is
prudent to give him information about reducing calories, fat, and cholesterol in his diet to help
prevent further weight gain.
3. A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m 2 .
What is the most appropriate amount for a weekly weight reduction goal?
A) .5 to 1 pound per week
B) 1 to 2.5 pounds per week
C) 2.5 to 3.5 pounds per week
D) 3.5 to 4.5 pounds per week
Ans: A
Chapter: 04
Feedback: Based on the NIH Obesity Guidelines, this is the weekly weight loss goal to strive for
to maintain long-term control of weight. More rapid weight loss than this does not result in a
better outcome at one year.
4. A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she
is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for
30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years,
which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at
that time his weight was 140 pounds. Today, his weight is 110 pounds.
Which one of the following questions would be the most important to ask if you suspect that he
has lung cancer?
A) Have you tried to force yourself to vomit after eating a meal?
B) Do you have heartburn/indigestion and diarrhea?
C) Do you have enough food to eat?
D) Have you tried to lose weight?
Ans: D
Chapter: 04
Feedback: This is important: If the patient hasn't tried to lose weight, then this weight loss is
inadvertent and poses concern for a neoplastic process, especially given his smoking history.
5. Common or concerning symptoms to inquire about in the General Survey and vital signs
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include all of the following except:
A) Changes in weight
B) Fatigue and weakness
C) Cough
D) Fever and chills
Ans: C
Chapter: 04
Feedback: This symptom is more appropriate to the respiratory review of systems.
6. You are beginning the examination of a patient. All of the following areas are important to
observe as part of the General Survey except:
A) Level of consciousness
B) Signs of distress
C) Dress, grooming, and personal hygiene
D) Blood pressure
Ans: D
Chapter: 04
Feedback: Blood pressure is a vital sign, not part of the General Survey.
7. A 55-year-old bookkeeper comes to your office for a routine visit. You note that on a
previous visit for treatment of contact dermatitis, her blood pressure was elevated. She does not
have prior elevated readings and her family history is negative for hypertension. You measure
her blood pressure in your office today. Which of the following factors can result in a false high
reading?
A) Blood pressure cuff is tightly fitted.
B) Patient is seated quietly for 10 minutes prior to measurement.
C) Blood pressure is measured on a bare arm.
D) Patient's arm is resting, supported by your arm at her mid-chest level as you stand to measure
the blood pressure.
Ans: A
Chapter: 04
Feedback: A blood pressure cuff that is too tightly fitted can result in a false high reading. The
other answers are important to observe to obtain an accurate blood pressure reading. JNC-7 also
mentions the importance of having the back supported when obtaining blood pressure in the
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sitting position.
8. A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling
in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are
the student assigned to do the patient's complete history and physical examination. When you
palpate the pulse, what do you expect to feel?
A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal
D) Bigeminal
Ans: B
Chapter: 04
Feedback: Congestive heart failure is characterized by decreased stroke volume or increased
peripheral vascular resistance, which would result in a small-amplitude, weak pulse. Subtle
differences in amplitude are usually best detected in large arteries close to the heart, like the
carotid pulse. You may not be able to notice these in other locations.
9. An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You
measure the patient's temperature and it is 104 degrees Fahrenheit. What type of pulse would you
expect to feel during his initial examination?
A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal
D) Bigeminal
Ans: A
Chapter: 04
Feedback: Fever results in an increased stroke volume, which results in a large-amplitude,
forceful pulse. Later in the course of the illness, if dehydration and shock result, you may expect
small amplitude and weak pulses.
10. A 25-year-old type 1 diabetic clerk presents to the emergency room with shortness of breath
and states that his blood sugar was 605 at home. You diagnose the patient with diabetic
ketoacidosis. What is the expected pattern of breathing?
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A) Normal
B) Rapid and shallow
C) Rapid and deep
D) Slow
Ans: C
Chapter: 04
Feedback: This is the expected rate and depth in diabetic ketoacidosis. The body is trying to rid
itself of carbon dioxide to compensate for the acidosis. This is known as Kussmaul's breathing
and is seen in other causes of acidosis as well.
11. Mrs. Lenzo weighs herself every day with a very accurate balance-type scale. She has
noticed that over the past 2 days she has gained 4 pounds. How would you best explain this?
A) Attribute this to some overeating at the holidays.
B) Attribute this to wearing different clothing.
C) Attribute this to body fluid.
D) Attribute this to instrument inaccuracy.
Ans: C
Chapter: 04
Feedback: This amount of weight over a short period should make one think of body fluid
changes. You may consider a kidney problem or heart failure in your differential. The other
reasons should be considered as well, but this amount of weight gain over a short period usually
indicates causes other than excessive caloric intake. A rule of thumb for dieters is that an energy
excess of 3500 calories will cause a 1-pound weight gain, if the increase is to be attributed to
food intake.
12. Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and
obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing
weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell
him?
A) ―When you get down to your goal weight, you will feel so much better.‖
B) ―Some people seem to be able to lose weight and others just can't, no matter how hard they
try.‖
C) ―We are coming up with new medicines and methods to treat your conditions every day.‖
D) ―Even a weight loss of 10% can make a noticeable improvement in the problems you
mention.‖
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Ans: D
Chapter: 04
Feedback: Many patients trying to change a habit are overwhelmed by how far they are from
their goal. As the proverb says: ―A journey of a thousand miles begins with one step.‖ Many
patients find it empowering to know that they can achieve a small goal, such as a loss of 1 pound
per week. They must be reminded that this process will take time and that slow weight loss is
more successful long-term. Research has shown that significant benefits often come with even a
10% weight loss.
13. Jenny is one of your favorite patients who usually shares a joke with you and is nattily
dressed. Today she is dressed in old jeans, lacks makeup, and avoids eye contact. To what do
you attribute these changes?
A) She is lacking sleep.
B) She is fatigued from work.
C) She is running into financial difficulty.
D) She is depressed.
Ans: D
Chapter: 04
Feedback: It is important to use all of your skills and memory of an individual patient to guide
your thought process. She is not described as sleepy. Work fatigue would most likely not cause
avoidance of eye contact. Financial difficulties would not necessarily deplete a nice wardrobe.
It is most likely that she is depressed or in another type of difficulty.
14. You are seeing an older patient who has not had medical care for many years. Her vital
signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain.
You notice that she has some hypertensive changes in her retinas and you find mild proteinuria
on a urine test in your office. You expected the BP to be higher. She is not on any medications.
What do you think is causing this BP reading, which doesn't correlate with the other findings?
A) It is caused by an ―auscultatory gap.‖
B) It is caused by a cuff size error.
C) It is caused by the patient's emotional state.
D) It is caused by resolution of the process which caused her retinopathy and kidney problems.
Ans: A
Chapter: 04
Feedback: The blood pressure is unusual in this case in that the systolic pressure is normal while
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the diastolic pressure is elevated. Especially with the retinal and urinary findings, you should
consider that the BP may be much higher and that an auscultatory gap was missed. This can be
avoided by checking for obliteration of the radial pulse while the cuff is inflated. Although a
large cuff can cause a slightly lower BP on a patient with a small arm, this does not account for
the elevated DBP. Emotional upset usually causes elevation of the BP. Although a process
which caused the retinopathy and kidney problems may have resolved, leaving these findings, it
is a dangerous assumption that this is the sole cause of the problems seen in this patient.
15. Despite having high BP readings in the office, Mr. Kelly tells you that his readings at home
are much lower. He checks them twice a day at the same time of day and has kept a log. How do
you respond?
A) You diagnose ―white coat hypertension.‖
B) You assume he is quite nervous when he comes to your office.
C) You question the accuracy of his measurements.
D) You question the accuracy of your measurements.
Ans: C
Chapter: 04
Feedback: It is not uncommon to see differences in a patient's home measurements and your
own in the office. Presuming that this is ―white coat hypertension‖ can be dangerous because
this condition is not usually treated. This allows for the effects of a missed diagnosis of
hypertension to go unchecked. It is also very difficult to judge if a patient is outwardly nervous.
You should always consider that your measurements are not accurate as well, but the fact that
you and your staff are well-trained and perform this procedure on hundreds of patients a week
makes this less likely. Ideally, you would ask the patient to bring in his BP equipment and take a
simultaneous reading with you to make sure that he is getting an accurate reading.
16. You are observing a patient with heart failure and notice that there are pauses in his
breathing. On closer examination, you notice that after the pauses the patient takes progressively
deeper breaths and then progressively shallower breaths, which are followed by another apneic
spell. The patient is not in any distress. You make the diagnosis of:
A) Ataxic (Biot's) breathing
B) Cheyne-Stokes respiration
C) Kussmaul's respiration
D) COPD with prolonged expiration
Ans: B
Chapter: 04
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Feedback: Cheyne-Stokes respiration can be seen in patients with heart failure and is usually not
a sign of an immediate problem. Ataxic breathing is very irregular in rhythm and depth and is
seen with brain injury. Kussmaul's respiration is seen in patients with a metabolic acidosis, as
they are trying to rid their bodies of carbon dioxide to compensate. Respirations in COPD are
usually regular and are not usually associated with apneic episodes.
17. Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even
a light touch causes this burning sensation to worsen. On examination, you note a rash with
small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his
right side. What type of pain is this?
A) Idiopathic pain
B) Neuropathic pain
C) Nociceptive or somatic pain
D) Psychogenic pain
Ans: B
Chapter: 04
Feedback: This vignette is consistent with a diagnosis of herpes zoster, or shingles. This is
caused by reemergence of dormant varicella (chickenpox) viruses from Mr. Garcia's nerve root.
The characteristic burning quality without a history of an actual burn makes one think of
neuropathic pain. It will most likely remain for months after the rash has resolved. There is no
evidence of physical injury and this is a peculiar distribution, making nociceptive pain less
likely. There is no evidence of a psychogenic etiology for this, and the presence of a rash makes
this possibility less likely as well. Because of your astute diagnostic abilities, the pain is not
idiopathic.
18. A 50-year-old body builder is upset by a letter of denial from his life insurance company.
He is very lean but has gained 2 pounds over the past 6 months. You personally performed his
health assessment and found no problems whatsoever. He says he is classified as ―high risk‖
because of obesity. What should you do next?
A) Explain that even small amounts of weight gain can classify you as obese.
B) Place him on a high-protein, low-fat diet.
C) Advise him to increase his aerobic exercise for calorie burning.
D) Measure his waist.
Ans: D
Chapter: 04
Feedback: The patient most likely had a high BMI because of increased muscle mass. In this
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situation, it is important to measure his waist. It is most likely under 40 inches, which makes
obesity unlikely (even to an insurance company). It is important that you personally contact the
company and explain your reasoning. Be prepared to back your argument with data. A special
diet is unlikely to be of much use, and more aerobic exercise, while probably a good idea for
most, is redundant for this individual.
19. Ms. Wright comes to your office, complaining of palpitations. While checking her pulse
you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different.
It sounds like a triplet rather than the usual ―lub dup.‖ How would you document your
examination?
A) Regular rate and rhythm
B) Irregularly irregular rhythm
C) Regularly irregular rhythm
D) Bradycardia
Ans: C
Chapter: 04
Feedback: Because this unusual beat occurs every fourth set of heart sounds, it is regularly
irregular. This is most consistent with ventricular premature contractions (or VPCs). This is
generally a common and benign rhythm. An irregularly irregular rhythm is a classic finding in
atrial fibrillation. The rhythm is very random in character. Bradycardia refers to the rate, not the
rhythm.
Chapter 5 Cultural and Spiritual Assessment
MULTIPLE CHOICE
1. The nurse is reviewing the development of culture. Which statement is correct regarding the
development of ones culture? Culture is:
a. Genetically determined on the basis of racial background.
b. Learned through language acquisition and socialization.
c. A nonspecific phenomenon and is adaptive but unnecessary.
d. Biologically determined on the basis of physical characteristics.
ANS: B
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Culture is learned from birth through language acquisition and socialization. It is not biologically
or genetically determined and is learned by the individual.
2. During a class on the aspects of culture, the nurse shares that culture has four basic
characteristics. Which statement correctly reflects one of these characteristics?
a. Cultures are static and unchanging, despite changes around them.
b. Cultures are never specific, which makes them hard to identify.
c. Culture is most clearly reflected in a persons language and behavior.
d. Culture adapts to specific environmental factors and available natural resources.
ANS: D
Culture has four basic characteristics. Culture adapts to specific conditions related to
environmental and technical factors and to the availability of natural resources, and it is dynamic
and ever changing. Culture is learned from birth through the process of language acquisition and
socialization, but it is not most clearly reflected in ones language and behavior.
3. During a seminar on cultural aspects of nursing, the nurse recognizes that the definition stating
the specific and distinct knowledge, beliefs, skills, and customs acquired by members of a society
reflects which term?
a. Mores
b. Norms
c. Culture
d. Social learning
ANS: C
The culture that develops in any given society is always specific and distinctive, encompassing
all of the knowledge, beliefs, customs, and skills acquired by members of the society. The other
terms do not fit the given definition.
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4. When discussing the use of the term subculture, the nurse recognizes that it is best described
as:
a. Fitting as many people into the majority culture as possible.
b. Defining small groups of people who do not want to be identified with the larger
culture.
c. Singling out groups of people who suffer differential and unequal treatment as a
result of cultural variations.
d. Identifying fairly large groups of people with shared characteristics that are not
common to all members of a culture.
ANS: D
Within cultures, groups of people share different beliefs, values, and attitudes. Differences occur
because of ethnicity, religion, education, occupation, age, and gender. When such groups
function within a large culture, they are referred to as subcultural groups.
5. When reviewing the demographics of ethnic groups in the United States, the nurse recalls that
the largest and fastest growing population is:
a. Hispanic.
b. Black.
c. Asian.
d. American Indian.
ANS: A
Hispanics are the largest and fastest growing population in the United States, followed by
Asians, Blacks, American Indians and Alaska natives, and other groups.
6. During an assessment, the nurse notices that a patient is handling a small charm that is tied to
a leather strip around his neck. Which action by the nurse is appropriate?
a. Ask the patient about the item and its significance.
b. Ask the patient to lock the item with other valuables in the hospitals safe.
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c. Tell the patient that a family member should take valuables home.
d. No action is necessary.
ANS: A
The nurse should inquire about the amulets meaning. Amulets, such as charms, are often
considered an important means of protection from evil spirits by some cultures.
7. The nurse manager is explaining culturally competent care during a staff meeting. Which
statement accurately describes the concept of culturally competent care? The caregiver:
a. Is able to speak the patients native language.
b. Possesses some basic knowledge of the patients cultural background.
c. Applies the proper background knowledge of a patients cultural background to
provide the best possible health care.
d. Understands and attends to the total context of the patients situation.
ANS: D
Culturally competent implies that the caregiver understands and attends to the total context of the
individuals situation. This competency includes awareness of immigration status, stress factors,
other social factors, and cultural similarities and differences. It does not require the caregiver to
speak the patients native language.
8. The nurse recognizes that an example of a person who is heritage consistent would be a:
a. Woman who has adapted her clothing to the clothing style of her new country.
b. Woman who follows the traditions that her mother followed regarding meals.
c. Man who is not sure of his ancestors country of origin.
d. Child who is not able to speak his parents native language.
ANS: B
Someone who is heritage consistent lives a lifestyle that reflects his or her traditional heritage,
not the norms and customs of the new country.
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9. After a class on culture and ethnicity, the new graduate nurse reflects a correct understanding
of the concept of ethnicity with which statement?
a. Ethnicity is dynamic and ever changing.
b. Ethnicity is the belief in a higher power.
c. Ethnicity pertains to a social group within the social system that claims shared
values and traditions.
d. Ethnicity is learned from birth through the processes of language acquisition and
socialization.
ANS: C
Ethnicity pertains to a social group within the social system that claims to have variable traits,
such as a common geographic origin, migratory status, religion, race, language, values,
traditions, symbols, or food preferences.Culture is dynamic, ever changing, and learned from
birth through the processes of language acquisition and socialization. Religion is the belief in a
higher power.
10. The nurse is comparing the concepts of religion and spirituality. Which of the following is an
appropriate component of ones spirituality?
a. Belief in and the worship of God or gods
b. Attendance at a specific church or place of worship
c. Personal effort made to find purpose and meaning in life
d. Being closely tied to ones ethnic background
ANS: C
Spirituality refers to each persons unique life experiences and his or her personal effort to find
purpose and meaning in life. The other responses apply to religion.
11. A woman who has lived in the United States for a year after moving from Europe has learned
to speak English and is almost finished with her college studies. She now dresses like her peers
and says that her family in Europe would hardly recognize her. This nurse recognizes that this
situation illustrates which concept?
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a. Assimilation
b. Heritage consistency
c. Biculturalism
d. Acculturation
ANS: A
Assimilation is the process by which a person develops a new cultural identity and becomes like
members of the dominant culture. This concept does not reflect heritage consistency.
Biculturalism is a dual pattern of identification; acculturation is the process of adapting to and
acquiring another culture.
12. The nurse is conducting a heritage assessment. Which question is most appropriate for this
assessment?
a. What is your religion?
b. Do you mostly participate in the religious traditions of your family?
c. Do you smoke?
d. Do you have a history of heart disease?
ANS: B
Asking questions about participation in the religious traditions of family enables the nurse to
assess a persons heritage. Simply asking about ones religion, smoking history, or health history
does not reflect heritage.
13. In the majority culture of America, coughing, sweating, and diarrhea are symptoms of an
illness. For some individuals of Mexican-American origin, however, these symptoms are a
normal part of living. The nurse recognizes that this difference is true, probably because
Mexican-Americans:
a. Have less efficient immune systems and are often ill.
b. Consider these symptoms part of normal living, not symptoms of ill health.
c. Come from Mexico, and coughing is normal and healthy there.
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d. Are usually in a lower socioeconomic group and are more likely to be sick.
ANS: B
The nurse needs to identify the meaning of health to the patient, remembering that concepts are
derived, in part, from the way in which members of the cultural group define health.
14. The nurse is reviewing theories of illness. The germ theory, which states that microscopic
organisms such as bacteria and viruses are responsible for specific disease conditions, is a basic
belief of which theory of illness?
a. Holistic
b. Biomedical
c. Naturalistic
d. Magicoreligious
ANS: B
Among the biomedical explanations for disease is the germ theory, which states that microscopic
organisms such as bacteria and viruses are responsible for specific disease conditions. The
naturalistic, or holistic, perspective holds that the forces of nature must be kept in natural
balance. The magicoreligious perspective holds that supernatural forces dominate and cause
illness or health.
15. An Asian-American woman is experiencing diarrhea, which is believed to be cold or yin. The
nurse expects that the woman is likely to try to treat it with:
a. Foods that are hot or yang.
b. Readings and Eastern medicine meditations.
c. High doses of medicines believed to be cold.
d. No treatment is tried because diarrhea is an expected part of life.
ANS: A
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Yin foods are cold and yang foods are hot. Cold foods are eaten with a hot illness, and hot foods
are eaten with a cold illness. The other explanations do not reflect the yin/yang theory.
16. Many Asians believe in the yin/yang theory, which is rooted in the ancient Chinese
philosophy of Tao. Which statement most accurately reflects health in an Asian with this belief?
a. A person is able to work and produce.
b. A person is happy, stable, and feels good.
c. All aspects of the person are in perfect balance.
d. A person is able to care for others and function socially.
ANS: C
Many Asians believe in the yin/yang theory, in which health is believed to exist when all aspects
of the person are in perfect balance. The other statements do not describe this theory.
17. Illness is considered part of lifes rhythmic course and is an outward sign of disharmony
within. This statement most accurately reflects the views about illness from which theory?
a. Naturalistic
b. Biomedical
c. Reductionist
d. Magicoreligious
ANS: A
The naturalistic perspective states that the laws of nature create imbalances, chaos, and disease.
From the perspective of the Chinese, for example, illness is not considered an introducing agent;
rather, illness is considered a part of lifes rhythmic course and an outward sign of disharmony
within. The other options are not correct.
18. An individual who takes the magicoreligious perspective of illness and disease is likely to
believe that his or her illness was caused by:
a. Germs and viruses.
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b. Supernatural forces.
c. Eating imbalanced foods.
d. An imbalance within his or her spiritual nature.
ANS: B
The basic premise of the magicoreligious perspective is that the world is seen as an arena in
which supernatural forces dominate. The fate of the world and those in it depends on the actions
of supernatural forces for good or evil. The other answers do not reflect the magicoreligious
perspective.
19. If an American Indian woman has come to the clinic to seek help with regulating her
diabetes, then the nurse can expect that she:
a. Will comply with the treatment prescribed.
b. Has obviously given up her belief in naturalistic causes of disease.
c. May also be seeking the assistance of a shaman or medicine man.
d. Will need extra help in dealing with her illness and may be experiencing a crisis
of faith.
ANS: C
When self-treatment is unsuccessful, the individual may turn to the lay or folk healing systems,
to spiritual or religious healing, or to scientific biomedicine. In addition to seeking help from a
biomedical or scientific health care provider, patients may also seek help from folk or religious
healers.
20. An older Mexican-American woman with traditional beliefs has been admitted to an inpatient
care unit. A culturally sensitive nurse would:
a. Contact the hospital administrator about the best course of action.
b. Automatically get a curandero for her, because requesting one herself is not
culturally appropriate.
c. Further assess the patients cultural beliefs and offer the patient assistance in
contacting a curandero or priest if she desires.
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d. Ask the family what they would like to do because Mexican-Americans
traditionally give control of decision making to their families.
ANS: C
In addition to seeking help from the biomedical or scientific health care provider, patients may
also seek help from folk or religious healers. Some people, such as those of Mexican-American
or American-Indian origins, may believe that the cure is incomplete unless the body, mind, and
spirit are also healed (although the division of the person into parts is a Western concept).
Chapter 6 Physical Examination: Getting Started
MULTIPLE CHOICE
1. The nurse is performing a general survey. Which action is a component of the general survey?
a. Observing the patients body stature and nutritional status
b. Interpreting the subjective information the patient has reported
c. Measuring the patients temperature, pulse, respirations, and blood pressure
d. Observing specific body systems while performing the physical assessment
ANS: A
The general survey is a study of the whole person that includes observing the patients physical
appearance, body structure, mobility, and behavior.
2. When measuring a patients weight, the nurse is aware of which of these guidelines?
a. The patient is always weighed wearing only his or her undergarments.
b. The type of scale does not matter, as long as the weights are similar from day to
day.
c. The patient may leave on his or her jacket and shoes as long as these are
documented next to the weight.
d. Attempts should be made to weigh the patient at approximately the same time of
day, if a sequence of weights is necessary.
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ANS: D
A standardized balance scale is used to measure weight. The patient should remove his or her
shoes and heavy outer clothing. If a sequence of repeated weights is necessary, then the nurse
should attempt to weigh the patient at approximately the same time of day and with the same
types of clothing worn each time.
3. A patients weekly blood pressure readings for 2 months have ranged between 124/84 mm Hg
and 136/88 mm Hg, with an average reading of 126/86 mm Hg. The nurse knows that this blood
pressure falls within which blood pressure category?
a. Normal blood pressure
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension
ANS: B
According to the Seventh Report of the Joint National Committee (JNC 7) guidelines,
prehypertension blood pressure readings are systolic readings of 120 to 139 mm Hg or diastolic
readings of 50 to 89 mm Hg.
4. During an examination of a child, the nurse considers that physical growth is the best index of
a childs:
a. General health.
b. Genetic makeup.
c. Nutritional status.
d. Activity and exercise patterns.
ANS: A
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Physical growth is the best index of a childs general health; recording the childs height and
weight helps determine normal growth patterns.
5. A 1-month-old infant has a head measurement of 34 cm and has a chest circumference of 32
cm. Based on the interpretation of these findings, the nurse would:
a. Refer the infant to a physician for further evaluation.
b. Consider these findings normal for a 1-month-old infant.
c. Expect the chest circumference to be greater than the head circumference.
d. Ask the parent to return in 2 weeks to re-evaluate the head and chest
circumferences.
ANS: B
The newborns head measures approximately 32 to 38 cm and is approximately 2 cm larger than
the chest circumference. Between 6 months and 2 years, both measurements are approximately
the same, and after age 2 years, the chest circumference is greater than the head circumference.
6. The nurse is assessing an 80-year-old male patient. Which assessment findings would be
considered normal?
a. Increase in body weight from his younger years
b. Additional deposits of fat on the thighs and lower legs
c. Presence of kyphosis and flexion in the knees and hips
d. Change in overall body proportion, including a longer trunk and shorter
extremities
ANS: C
Changes that occur in the aging person include more prominent bony landmarks, decreased body
weight (especially in men), a decrease in subcutaneous fat from the face and periphery, and
additional fat deposited on the abdomen and hips. Postural changes of kyphosis and slight
flexion in the knees and hips also occur.
7. The nurse should measure rectal temperatures in which of these patients?
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a. School-age child
b. Older adult
c. Comatose adult
d. Patient receiving oxygen by nasal cannula
ANS: C
Rectal temperatures should be taken when the other routes are impractical, such as for comatose
or confused persons, for those in shock, or for those who cannot close the mouth because of
breathing or oxygen tubes, a wired mandible, or other facial dysfunctions.
8. The nurse is preparing to measure the length, weight, chest, and head circumference of a 6month-old infant. Which measurement technique is correct?
a. Measuring the infants length by using a tape measure
b. Weighing the infant by placing him or her on an electronic standing scale
c. Measuring the chest circumference at the nipple line with a tape measure
d. Measuring the head circumference by wrapping the tape measure over the nose
and cheekbones
ANS: C
To measure the chest circumference, the tape is encircled around the chest at the nipple line. The
length should be measured on a horizontal measuring board. Weight should be measured on a
platform-type balance scale. Head circumference is measured with the tape around the hea d,
aligned at the eyebrows, and at the prominent frontal and occipital bonesthe widest span is
correct.
9. The nurse knows that one advantage of the tympanic membrane thermometer (TMT) is that:
a. Rapid measurement is useful for uncooperative younger children.
b. Using the TMT is the most accurate method for measuring body temperature in
newborn infants.
c. Measuring temperature using the TMT is inexpensive.
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d. Studies strongly support the use of the TMT in children under the age 6 years.
ANS: A
The TMT is useful for young children who may not cooperate for oral temperatures and fear
rectal temperatures. However, the use a TMT with newborn infants and young children is
conflicting.
10. When assessing an older adult, which vital sign changes occur with aging?
a. Increase in pulse rate
b. Widened pulse pressure
c. Increase in body temperature
d. Decrease in diastolic blood pressure
ANS: B
With aging, the nurse keeps in mind that the systolic blood pressure increases, leading to
widened pulse pressure. With many older people, both the systolic and diastolic pressures
increase. The pulse rate and temperature do not increase.
11. The nurse is examining a patient who is complaining of feeling cold. Which is a mechanism
of heat loss in the body?
a. Exercise
b. Radiation
c. Metabolism
d. Food digestion
ANS: B
The body maintains a steady temperature through a thermostat or feedback mechanism, which is
regulated in the hypothalamus of the brain. The hypothalamus regulates heat production from
metabolism, exercise, food digestion, and external factors with heat loss through radiation,
evaporation of sweat, convection, and conduction.
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12. When measuring a patients body temperature, the nurse keeps in mind that body temperature
is influenced by:
a. Constipation.
b. Patients emotional state.
c. Diurnal cycle.
d. Nocturnal cycle.
ANS: C
Normal temperature is influenced by the diurnal cycle, exercise, and age. The other responses do
not influence body temperature.
13. When evaluating the temperature of older adults, the nurse should remember which aspect
about an older adults body temperature?
a. The body temperature of the older adult is lower than that of a younger adult.
b. An older adults body temperature is approximately the same as that of a young
child.
c. Body temperature depends on the type of thermometer used.
d. In the older adult, the body temperature varies widely because of less effective
heat control mechanisms.
ANS: A
In older adults, the body temperature is usually lower than in other age groups, with a mean
temperature of 36.2 C.
14. A 60-year-old male patient has been treated for pneumonia for the past 6 weeks. He is seen
today in the clinic for an unexplained weight loss of 10 pounds over the last 6 weeks. The nurse
knows that:
a. Weight loss is probably the result of unhealthy eating habits.
b. Chronic diseases such as hypertension cause weight loss.
c. Unexplained weight loss often accompanies short-term illnesses.
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d. Weight loss is probably the result of a mental health dysfunction.
ANS: C
An unexplained weight loss may be a sign of a short-term illness or a chronic illness such as
endocrine disease, malignancy, depression, anorexia nervosa, or bulimia.
15. When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a
tripod position, leaning forward with arms braced on the chair. On the basis of this observation,
the nurse should:
a. Assume that the patient is eager and interested in participating in the interview.
b. Evaluate the patient for abdominal pain, which may be exacerbated in the sitting
position.
c. Assume that the patient is having difficulty breathing and assist him to a supine
position.
d. Recognize that a tripod position is often used when a patient is having respiratory
difficulties.
ANS: D
Assuming a tripod positionleaning forward with arms braced on chair armsoccurs with chronic
pulmonary disease. The other actions or assumptions are not correct.
16. Which of these actions illustrates the correct technique the nurse should use when assessing
oral temperature with a mercury thermometer?
a. Wait 30 minutes if the patient has ingested hot or iced liquids.
b. Leave the thermometer in place 3 to 4 minutes if the patient is afebrile.
c. Place the thermometer in front of the tongue, and ask the patient to close his or
her lips.
d. Shake the mercury-in-glass thermometer down to below 36.6 C before taking the
temperature.
ANS: B
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The thermometer should be left in place 3 to 4 minutes if the person is afebrile and up to 8
minutes if the person is febrile. The nurse should wait 15 minutes if the person has just ingested
hot or iced liquids and 2 minutes if he or she has just smoked.
17. The nurse is taking temperatures in a clinic with a TMT. Which statement is true regarding
use of the TMT?
a. A tympanic temperature is more time consuming than a rectal temperature.
b. The tympanic method is more invasive and uncomfortable than the oral method.
c. The risk of cross-contamination is reduced, compared with the rectal route.
d. The tympanic membrane most accurately reflects the temperature in the
ophthalmic artery.
ANS: C
The TMT is a noninvasive, nontraumatic device that is extremely quick and efficient. The chance
of cross-contamination with the TMT is minimal because the ear canal is lined with skin, not
mucous membranes.
18. To assess a rectal temperature accurately in an adult, the nurse would:
a. Use a lubricated blunt tip thermometer.
b. Insert the thermometer 2 to 3 inches into the rectum.
c. Leave the thermometer in place up to 8 minutes if the patient is febrile.
d. Wait 2 to 3 minutes if the patient has recently smoked a cigarette.
ANS: A
A lubricated rectal thermometer (with a short, blunt tip) is inserted only 2 to 3 cm (1 inch) into
the adult rectum and left in place for 2 minutes. Cigarette smoking does not alter rectal
temperatures.
19. Which technique is correct when the nurse is assessing the radial pulse of a patient?
The pulse is counted for:
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a. 1 minute, if the rhythm is irregular.
b. 15 seconds and then multiplied by 4, if the rhythm is regular.
c. 2 full minutes to detect any variation in amplitude.
d. 10 seconds and then multiplied by 6, if the patient has no history of cardiac
abnormalities.
ANS: A
Recent research suggests that the 30-second interval multiplied by 2 is the most accurate and
efficient technique when heart rates are normal or rapid and when rhythms are regular. If the
rhythm is irregular, then the pulse is counted for 1 full minute.
20. When assessing a patients pulse, the nurse should also notice which of these characteristics?
a. Force
b. Pallor
c. Capillary refill time
d. Timing in the cardiac cycle
ANS: A
The pulse is assessed for rate, rhythm, and force.
Chapter 7 Beginning the Physical Examination: General Survey, Vital Signs, and
Pain
Multiple Choice
1. A 15-year-old high school sophomore and her mother come to your clinic because the mother
is concerned about her daughter's weight. You measure her daughter's height and weight and
obtain a BMI of 19.5 kg/m2 . Based on this information, which of the following is appropriate?
A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in her diet because
she is obese.
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Ans: B
Feedback: The patient has a normal BMI; the range for a normal BMI is 18.5 to 24.9 kg/m 2 .
You may be able to give the patient and her mother the lower limit of normal in pounds for her
daughter's height, or instruct her in how to use a BMI table.
2. A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is
26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate
counsel for the patient during the visit?
A) Refer the patient to a nutritionist because he is anorexic.
B) Reassure the patient that he has a normal body weight.
C) Give the patient information about reduction of fat, cholesterol, and calories because he is
overweight.
D) Give the patient information about reduction of fat and cholesterol because he is obese.
Ans: C
Feedback: The patient has a BMI in the overweight range, which is 25.0 to 29.9 kg/m2 . It is
prudent to give him information about reducing calories, fat, and cholesterol in his diet to help
prevent further weight gain.
3. A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m 2 .
What is the most appropriate amount for a weekly weight reduction goal?
A) .5 to 1 pound per week
B) 1 to 2.5 pounds per week
C) 2.5 to 3.5 pounds per week
D) 3.5 to 4.5 pounds per week
Ans: A
Feedback: Based on the NIH Obesity Guidelines, this is the weekly weight loss goal to strive for
to maintain long-term control of weight. More rapid weight loss than this does not result in a
better outcome at one year.
4. A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because
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