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COMPLETE TEST BANK FOR BATES NURSING GUIDE TO PHYSICAL
EXAMINATION AND HISTORY TAKING 3rd EDITION BY HOGA LATEST 2025
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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Ans:
B
Ans: A
Chapter:
01
Chapter: 01
Feedback:
This is
is information
a measurement
obtained
by the hospitalization
examiner, so it and
is considered
Feedback: This
about
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should beobjective
placed indata.
the
The
is unlikely
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adultpatient
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If be
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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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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, about
like a headline,
andhospitalization
further details should
be sought
in the
Feedback:
is information
a significant
and should
be placed
inpresent
the
illness
section.
The
above
information
is
a
chief
complaint.
adult illnesses section. If the patient is being seen 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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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 1obese 1patient. 1What 1should 1the 1nurse 1do 1next?
a. Ask 1the 1patient 1to 1take 1deep 1breaths 1to 1relax 1the 1abdominal 1musculature.
b. Consider 1this 1finding 1as 1normal, 1and 1proceed 1with 1the 1abdominal 1assessment.
c. Increase 1the 1amount 1of 1strength 1used 1when 1attempting 1to 1percuss 1over
1the 1abdomen.
d. Decrease 1the 1amount 1of 1strength 1used 1when 1attempting 1to 1percuss 1over
1the 1abdomen.
ANS: 1C
The 1thickness 1of 1the 1persons 1body 1wall 1will 1be 1a 1factor. 1The 1nurse 1needs 1a 1stronger 1percussion
1
stroke 1for 1persons 1with 1obese 1or 1very 1muscular 1body 1walls. 1The 1force 1of 1the 1blow 1determines
1
the 1loudness 1of 1the 1note. 1The 1other 1actions 1are 1not 1correct.
11. The 1nurse 1hears 1bilateral 1loud, 1long, 1and 1low 1tones 1when 1percussing 1over 1the 1lungs 1of 1a
4- 1year-old 1child. 1The 1nurse 1should:
1
a. Palpate 1over 1the 1area 1for 1increased 1pain 1and 1tenderness.
b. Ask 1the 1child 1to 1take 1shallow 1breaths, 1and 1percuss 1over 1the 1area 1again.
c. Immediately 1refer 1the 1child 1because 1of 1an 1increased 1amount 1of 1air 1in 1the 1lungs.
d. Consider 1this 1finding 1as 1normal 1for 1a 1child 1this 1age, 1and 1proceed 1with
1the 1examination.
ANS: 1D
Percussion 1notes 1that 1are 1loud 1in 1amplitude, 1low 1in 1pitch, 1of 1a 1booming 1quality, 1and 1long 1in
1
duration 1are 1normal 1over 1a 1childs 1lung.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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 1the 1patients 1respirations.
b. Bilaterally 1percuss 1the 1thorax, 1noting 1any 1differences 1in 1percussion 1tones.
c. Call 1for 1a 1chest 1x-ray 1study, 1and 1wait 1for 1the 1results 1before 1beginning
1an 1assessment.
d. Inspect 1the 1thorax 1for 1any 1new 1masses 1and 1bleeding 1associated 1with 1respirations.
ANS: 1B
Percussion 1is 1always 1available, 1portable, 1and 1offers 1instant 1feedback 1regarding 1changes 1in
1
underlying 1tissue 1density, 1which 1may 1yield 1clues 1of 1the 1patients 1physical 1status.
13. The 1nurse 1is 1teaching 1a 1class 1on 1basic 1assessment 1skills. 1Which 1of 1these 1statements 1is 1true
regarding 1the 1stethoscope 1and 1its 1use?
a. Slope 1of 1the 1earpieces 1should 1point 1posteriorly 1(toward 1the 1occiput).
b. Although 1the 1stethoscope 1does 1not 1magnify 1sound, 1it 1does 1block 1out
1extraneous 1room 1noise.
c. Fit 1and 1quality 1of 1the 1stethoscope 1are 1not 1as 1important 1as 1its 1ability 1to
1magnify 1sound.
d. Ideal 1tubing 1length 1should 1be 122 1inches 1to 1dampen 1the 1distortion 1of 1sound.
ANS: 1B
The 1stethoscope 1does 1not 1magnify 1sound, 1but 1it 1does 1block 1out 1extraneous 1room 1sounds. 1The
1
slope 1of 1the 1earpieces 1should 1point 1forward 1toward 1the 1examiners 1nose. 1Long 1tubing 1will
distort 1sound. 1The 1fit 1and 1quality 1of 1the 1stethoscope 1are 1both 1important.
1
14. The 1nurse 1is 1preparing 1to 1use 1a 1stethoscope 1for 1auscultation. 1Which 1statement 1is 1true
regarding 1the 1diaphragm 1of 1the 1stethoscope? 1The 1diaphragm:
a. Is 1used 1to 1listen 1for 1high-pitched 1sounds.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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: 1A
The 1diaphragm 1of 1the 1stethoscope 1is 1best 1for 1listening 1to 1high-pitched 1sounds 1such 1as 1breath,
1
bowel, 1and 1normal 1heart 1sounds. 1It 1should 1be 1firmly 1held 1against 1the 1persons 1skin, 1firmly
enough 1to 1leave 1a 1ring. 1The 1bell 1of 1the 1stethoscope 1is 1best 1for 1soft, 1low-pitched 1sounds 1such 1as
1
extra 1heart 1sounds 1or 1murmurs.
1
15. Before 1auscultating 1the 1abdomen 1for 1the 1presence 1of 1bowel 1sounds 1on 1a 1patient, 1the
nurse 1should:
1
a. Warm 1the 1endpiece 1of 1the 1stethoscope 1by 1placing 1it 1in 1warm 1water.
b. Leave 1the 1gown 1on 1the 1patient 1to 1ensure 1that 1he 1or 1she 1does 1not 1get 1chilled
1during 1the 1examination.
c. Ensure 1that 1the 1bell 1side 1of 1the 1stethoscope 1is 1turned 1to 1the 1on 1position.
d. Check 1the 1temperature 1of 1the 1room, 1and 1offer 1blankets 1to 1the 1patient 1if 1he 1or
1she 1feels 1cold.
ANS: 1D
The 1examination 1room 1should 1be 1warm. 1If 1the 1patient 1shivers, 1then 1the 1involuntary 1muscle
1
contractions 1can 1make 1it 1difficult 1to 1hear 1the 1underlying 1sounds. 1The 1end 1of 1the 1stethoscope
1
should 1be 1warmed 1between 1the 1examiners 1hands, 1not 1with 1water. 1The 1nurse 1should 1never
listen 1through 1a 1gown. 1The 1diaphragm 1of 1the 1stethoscope 1should 1be 1used 1to 1auscultate 1for
1
1
bowel 1sounds.
16. The 1nurse 1will 1use 1which 1technique 1of 1assessment 1to 1determine 1the 1presence 1of
crepitus, 1swelling, 1and 1pulsations?
1
a. Palpation
b. Inspection
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Bates' 1Nursing 1Guide 1to 1Physical 1Examination 1and 1History 1Taking 1/ 1Edition 13 1Testbank
c. Percussion
d. Auscultation
ANS: 1A
Palpation 1applies 1the 1sense 1of 1touch 1to 1assess 1texture, 1temperature, 1moisture, 1organ 1location
and 1size, 1as 1well 1as 1any 1swelling, 1vibration 1or 1pulsation, 1rigidity 1or 1spasticity,
1
17. The 1nurse 1is 1preparing 1to 1use 1an 1otoscope 1for 1an 1examination. 1Which 1statement 1is 1true
regarding 1the 1otoscope? 1The 1otoscope:
a. Is 1often 1used 1to 1direct 1light 1onto 1the 1sinuses.
b. Uses 1a 1short, 1broad 1speculum 1to 1help 1visualize 1the 1ear.
c. Is 1used 1to 1examine 1the 1structures 1of 1the 1internal 1ear.
d. Directs 1light 1into 1the 1ear 1canal 1and 1onto 1the 1tympanic 1membrane.
ANS: 1D
The 1otoscope 1directs 1light 1into 1the 1ear 1canal 1and 1onto 1the 1tympanic 1membrane 1that 1divides 1the
1
external 1and 1middle 1ear. 1A 1short, 1broad 1speculum 1is 1used 1to 1visualize 1the 1nares.
18. An 1examiner 1is 1using 1an 1ophthalmoscope 1to 1examine 1a 1patients 1eyes. 1The 1patient 1has
1
astigmatism 1and 1is 1nearsighted. 1The 1use 1of 1which 1of 1these 1techniques 1would 1indicate 1that
the 1examination 1is 1being 1correctly 1performed?
1
a. Using 1the 1large 1full 1circle 1of 1light 1when 1assessing 1pupils 1that 1are 1not 1dilated
b. Rotating 1the 1lens 1selector 1dial 1to 1the 1black 1numbers 1to 1compensate
1for 1astigmatism
c. Using 1the 1grid 1on 1the 1lens 1aperture 1dial 1to 1visualize 1the 1external 1structures 1of
1the 1eye
d. Rotating 1the 1lens 1selector 1dial 1to 1bring 1the 1object 1into 1focus
ANS: 1D
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Bates' 1Nursing 1Guide 1to 1Physical 1Examination 1and 1History 1Taking 1/ 1Edition 13 1Testbank
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 1pupils. 1Rotating 1the 1lens 1selector 1dial 1brings 1the 1object 1into 1focus.
19. The 1nurse 1is 1unable 1to 1palpate 1the 1right 1radial 1pulse 1on 1a 1patient. 1The 1best 1action 1would 1be 1to:
a. Auscultate 1over 1the 1area 1with 1a 1fetoscope.
b. Use 1a 1goniometer 1to 1measure 1the 1pulsations.
c. Use 1a 1Doppler 1device 1to 1check 1for 1pulsations 1over 1the 1area.
d. Check 1for 1the 1presence 1of 1pulsations 1with 1a 1stethoscope.
ANS: 1C
Doppler 1devices 1are 1used 1to 1augment 1pulse 1or 1blood 1pressure 1measurements. 1Goniometers
1
measure 1joint 1range 1of 1motion. 1A 1fetoscope 1is 1used 1to 1auscultate 1fetal 1heart 1tones.
Stethoscopes 1are 1used 1to 1auscultate 1breath, 1bowel, 1and 1heart 1sounds.
1
20. The 1nurse 1is 1preparing 1to 1perform 1a 1physical 1assessment. 1The 1correct 1action 1by 1the 1nurse
is 1reflected 1by 1which 1statement? 1The 1nurse:
1
a. Performs 1the 1examination 1from 1the 1left 1side 1of 1the 1bed.
b. Examines 1tender 1or 1painful 1areas 1first 1to 1help 1relieve 1the 1patients 1anxiety.
c. Follows 1the 1same 1examination 1sequence, 1regardless 1of 1the 1patients 1age
1or 1condition.
d. Organizes 1the 1assessment 1to 1ensure 1that 1the 1patient 1does 1not 1change 1positions
1too 1often.
ANS: 1D
The 1steps 1of 1the 1assessment 1should 1be 1organized 1to 1ensure 1that 1the 1patient 1does 1not 1change
1
positions 1too 1often. 1The 1sequence 1of 1the 1steps 1of 1the 1assessment 1may 1differ, 1depending 1on 1the
age 1of 1the 1person 1and 1the 1examiners 1preference. 1Tender 1or 1painful 1areas 1should 1be 1assessed
1
1
last.
Chapter 1 3 1 Interviewing 1 and 1 Communication
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Multiple Choice
1. You are running late after your quarterly quality improvement meeting at the hospital and
have 1just 1gotten 1paged 1from 1the 1nurses' 1station 1because 1a 1family 1member 1of 1one 1of 1your
1patients 1wants 1to 1talk 1with 1you 1about 1that 1patient's 1care. 1You 1have 1clinic 1this 1afternoon 1and
1are 1double- 1booked 1for 1the 1first 1appointment 1time; 1three 1other 1patients 1also 1have 1arrived 1and
1are 1sitting 1in 1the 1waiting 1room. 1Which 1of 1the 1following 1demeanors 1is 1a 1behavior 1consistent
1with 1skilled 1interviewing 1when 1you 1walk 1into 1the 1examination 1room 1to 1speak 1with 1your 1first
1clinic 1patient?
A) Irritability
B) Impatience
C) Boredom
D) Calm
Ans: 1D
Chapter: 1 03
Feedback: 1The 1appearance 1of 1calmness 1and 1patience, 1even 1when 1time 1is 1limited, 1is 1the
1hallmark 1of 1a 1skilled 1interviewer.
2. Suzanne, 1a 125 1year 1old, 1comes 1to 1your 1clinic 1to 1establish 1care. 1You 1are 1the 1student
1preparing 1to 1go 1into 1the 1examination 1room 1to 1interview 1her. 1Which 1of 1the 1following 1is 1the
1most 1logical 1sequence 1for 1the 1patient–provider 1interview?
A) Establish 1the 1agenda, 1negotiate 1a 1plan, 1establish 1rapport, 1and 1invite 1the 1patient's 1story.
B) Invite 1the 1patient's 1story, 1negotiate 1a 1plan, 1establish 1the 1agenda, 1and 1establish 1rapport.
C) Greet 1the 1patient, 1establish 1rapport, 1invite 1the 1patient's 1story, 1establish 1the 1agenda, 1expand
1and 1clarify 1the 1patient's 1story, 1and 1negotiate 1a 1plan.
D) Negotiate 1a 1plan, 1establish 1an 1agenda, 1invite 1the 1patient's 1story, 1and 1establish 1rapport.
Ans: 1C
Chapter: 1 03
Feedback: 1This 1is 1the 1most 1productive 1sequence 1for 1the 1interview. 1Greeting 1patients 1and
1establishing 1rapport 1allows 1them 1to 1feel 1more 1comfortable 1before 1―inviting‖ 1them 1to 1relate 1their
1story. 1After 1hearing 1the 1patient's 1story, 1together 1you 1establish 1the 1agenda 1regarding 1the 1most
1important 1items 1to 1expand 1upon. 1At 1the 1end, 1together 1you 1negotiate 1the 1plan 1of 1diagnosis 1and
1treatment.
3. Alexandra 1is 1a 128-year-old 1editor 1who 1presents 1to 1the 1clinic 1with 1abdominal 1pain. 1The 1pain 1is
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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 1seven 1attributes 1of 1a 1symptom 1has 1been 1omitted?
A) Setting 1in 1which 1the 1symptom 1occurs
B) Associated 1manifestations
C) Quality
D) Timing
Ans: 1B
Chapter: 1 03
Feedback: 1The 1interviewer 1has 1not 1recorded 1whether 1or 1not 1the 1pain 1has 1been 1accompanied 1by
1nausea, 1vomiting, 1fever, 1chills, 1weight 1loss, 1and 1so 1on. 1Associated 1manifestations 1are 1additional
1symptoms 1that 1may 1accompany 1the 1initial 1chief 1complaint 1and 1that 1help 1the 1examiner 1to 1start
1refining 1his 1or 1her 1differential 1diagnosis.
4. Jason 1is 1a 141-year-old 1electrician 1who 1presents 1to 1the 1clinic 1for 1evaluation 1of 1shortness 1of
1breath. 1The 1shortness 1of 1breath 1occurs 1with 1exertion 1and 1improves 1with 1rest. 1It 1has 1been 1going
1on 1for 1several 1months 1and 1initially 1occurred 1only 1a 1couple 1of 1times 1a 1day 1with 1strenuous
1exertion; 1however, 1it 1has 1started 1to 1occur 1with 1minimal 1exertion 1and 1is 1happening 1more 1than 1a
1dozen 1times 1per 1day. 1The 1shortness 1of 1breath 1lasts 1for 1less 1than 15 1minutes 1at 1a 1time. 1He 1has
1no 1cough, 1chest 1pressure, 1chest 1pain, 1swelling 1in 1his 1feet, 1palpitations, 1orthopnea, 1or
1paroxysmal 1nocturnal 1dyspnea.
Which 1of 1the 1following 1symptom 1attributes 1was 1not 1addressed 1in 1this 1description?
A) Severity
B) Setting 1in 1which 1the 1symptom 1occurs
C) Timing
D) Associated 1manifestations
Ans: 1A
Chapter: 1 03
Feedback: 1The 1severity 1of 1the 1symptom 1was 1not 1recorded 1by 1the 1interviewer, 1so 1we 1have 1no
1understanding 1as 1to 1how 1bad 1the 1symptom 1is 1for 1this 1patient. 1The 1patient 1could 1have 1been
1asked 1to 1rate 1his 1pain 1on 1a 10 1to 110 1scale 1or 1used 1one 1of 1the 1other 1standardized 1pain 1scales
1available.
This 1allows 1the 1comparison 1of 1pain 1intensity 1before 1and 1after 1an 1intervention.
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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 1the 1patient 1that 1the 1urinary 1symptoms 1are 1benign 1and 1that 1she 1doesn't 1need
1to 1worry 1about 1it 1being 1a 1sign 1of 1cancer
C) Offering 1the 1patient 1multiple 1choices 1in 1order 1to 1clarify 1the 1character 1of 1the 1urinary
1symptoms 1that 1she 1is 1experiencing
D) Asking 1her 1to 1tell 1you 1exactly 1what 1she 1means 1when 1she 1states 1that 1she 1has 1a 1urinary
1tract 1infection
Ans: 1B
Chapter: 1 03
Feedback: 1Reassurance 1is 1not 1part 1of 1clarifying 1the 1patient's 1story; 1it 1is 1part 1of 1establishing
1rapport 1and 1empathizing 1with 1the 1patient.
6. Mr. 1W. 1is 1a 151-year-old 1auto 1mechanic 1who 1comes 1to 1the 1emergency 1room 1wanting 1to 1be
1checked 1out 1for 1the 1symptom 1of 1chest 1pain. 1As 1you 1listen 1to 1him 1describe 1his 1symptom 1in
1more 1detail, 1you 1say 1―Go 1on,‖ 1and 1later, 1―Mm-hmmm.‖ 1This 1is 1an 1example 1of 1which 1of 1the
1following 1skilled 1interviewing 1techniques?
A) Echoing
B) Nonverbal 1communication
C) Facilitation
D) Empathic 1response
Ans: 1C
Chapter: 1 03
Feedback: 1This 1is 1an 1example 1of 1facilitation. 1Facilitation 1can 1be 1posture, 1actions, 1or 1words 1that
1encourage 1the 1patient 1to 1say 1more.
7. Mrs. 1R. 1is 1a 192-year-old 1retired 1teacher 1who 1comes 1to 1your 1clinic 1accompanied 1by 1her
1daughter. 1You 1ask 1Mrs. 1R. 1why 1she 1came 1to 1your 1clinic 1today. 1She 1looks 1at 1her 1daughter
1and 1doesn't 1say 1anything 1in 1response 1to 1your 1question. 1This 1is 1an 1example 1of 1which 1type
1of 1challenging 1patient?
A) Talkative 1patient
B) Angry 1patient
C) Silent 1patient
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D) Hearing-impaired patient
Ans: C
Chapter: 03
Feedback: 1This 1is 1one 1example 1of 1a 1silent 1patient. 1There 1are 1many 1possibilities 1for 1this
1patient's 1silence: 1depression, 1dementia, 1the 1manner 1in 1which 1you 1asked 1the 1question, 1and 1so
1on.
8. Mrs. 1T. 1comes 1for 1her 1regular 1visit 1to 1the 1clinic. 1She 1is 1on 1your 1schedule 1because 1her
1regular 1provider 1is 1on 1vacation 1and 1she 1wanted 1to 1be 1seen. 1You 1have 1heard 1about 1her 1many
1times 1from 1your 1colleague 1and 1are 1aware 1that 1she 1is 1a 1very 1talkative 1person. 1Which 1of 1the
1following 1is 1a 1helpful 1technique 1to 1improve 1the 1quality 1of 1the 1interview 1for 1both 1the
1provider 1and 1the 1patient?
A) Allow 1the 1patient 1to 1speak 1uninterrupted 1for 1the 1duration 1of 1the 1appointment.
B) Briefly 1summarize 1what 1you 1heard 1from 1the 1patient 1in 1the 1first 15 1minutes 1and 1then 1try 1to
1have 1her 1focus 1on 1one 1aspect 1of 1what 1she 1told 1you.
C) Set 1the 1time 1limit 1at 1the 1beginning 1of 1the 1interview 1and 1stick 1with 1it, 1no 1matter 1what 1occurs
1in 1the 1course 1of 1the 1interview.
D) Allow 1your 1impatience 1to 1show 1so 1that 1the 1patient 1picks 1up 1on 1your 1nonverbal 1cue 1that
1the 1appointment 1needs 1to 1end.
Ans: 1B
Chapter: 1 03
Feedback: 1You 1can 1also 1say, 1―I 1want 1to 1make 1sure 1I 1take 1good 1care 1of 1this 1problem 1because 1it
1is 1very 1important. 1We 1may 1need 1to 1talk 1about 1the 1others 1at 1the 1next 1appointment. 1Is 1that 1okay
1with 1you?‖ 1This 1is 1a 1technique 1that 1can 1help 1you 1to 1change 1the 1subject 1but, 1at 1the 1same 1time,
1validate 1the 1patient's 1concerns; 1it 1also 1can 1provide 1more 1structure 1to 1the 1interview.
9. Mrs. 1H. 1comes 1to 1your 1clinic, 1wanting 1antibiotics 1for 1a 1sinus 1infection. 1When 1you 1enter
1the 1room, 1she 1appears 1to 1be 1very 1angry. 1She 1has 1a 1raised 1tone 1of 1voice 1and 1states 1that 1she
1has 1been 1waiting 1for 1the 1past 1hour 1and 1has 1to 1get 1back 1to 1work. 1She 1states 1that 1she 1is
1unimpressed 1by 1the 1reception 1staff, 1the 1nurse, 1and 1the 1clinic 1in 1general 1and 1wants 1to 1know
1why 1the 1office 1wouldn't 1call 1in 1an 1antibiotic 1for 1her. 1Which 1of 1the 1following 1techniques 1is
1not 1useful 1in 1helping 1to 1calm 1this 1patient?
A) Avoiding 1admission 1that 1you 1had 1a 1part 1in 1provoking 1her 1anger 1because 1you 1were 1late
B) Accepting 1angry 1feelings 1from 1the 1patient 1and 1trying 1not 1to 1get 1angry 1in 1return
C) Staying 1calm
D) Keeping 1your 1posture 1relaxed
Ans: 1A
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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 1be 1angry 1in 1a 1similar 1situation.
10. A 123-year-old 1graduate 1student 1comes 1to 1your 1clinic 1for 1evaluation 1of 1a 1urethral
1discharge. 1As 1the 1provider, 1you 1need 1to 1get 1a 1sexual 1history. 1Which 1one 1of 1the 1following
1questions 1is 1inappropriate 1for 1eliciting 1the 1information?
A) Are 1you 1sexually 1active?
B) When 1was 1the 1last 1time 1you 1had 1intimate 1physical 1contact 1with 1someone, 1and 1did 1that
1contact 1include 1sexual 1intercourse?
C) Do 1you 1have 1sex 1with 1men, 1women, 1or 1both?
D) How 1many 1sexual 1partners 1have 1you 1had 1in 1the 1last 16 1months?
Ans: 1A
Chapter: 1 03
Feedback: 1This 1is 1inappropriate 1because 1it 1is 1too 1vague. 1Given 1the 1complaint, 1you 1should
1probably 1assume 1that 1he 1is 1sexually 1active. 1Sometimes 1patients 1may 1respond 1to 1this 1question
1with 1the 1phrase 1―No, 1I 1just 1lie 1there.‖ 1 A 1specific 1sexual 1history 1will 1help 1you 1to 1assess 1this
1patient's 1risk 1for 1other 1sexually 1transmitted 1infections.
11. Mr. 1Q. 1is 1a 145-year-old 1salesman 1who 1comes 1to 1your 1office 1for 1evaluation 1of 1fatigue. 1He
1has 1come 1to 1the 1office 1many 1times 1in 1the 1past 1with 1a 1variety 1of 1injuries, 1and 1you 1suspect 1that
1he 1has 1a 1problem 1with 1alcohol. 1Which 1one 1of 1the 1following 1questions 1will 1be 1most 1helpful 1in
1diagnosing 1this 1problem?
A) You 1are 1an 1alcoholic, 1aren't 1you?
B) When 1was 1your 1last 1drink?
C) Do 1you 1drink 12 1to 13 1beers 1every 1weekend?
D) Do 1you 1drink 1alcohol 1when 1you 1are 1supposed 1to 1be 1working?
Ans: 1B
Chapter: 1 03
Feedback: 1This 1is 1a 1good 1opening 1question 1that 1is 1general 1and 1neutral 1in 1tone; 1depending 1on
1the 1timing, 1you 1will 1be 1able 1to 1ask 1for 1more 1specific 1information 1related 1to 1the 1patient's 1last
1drink. 1The 1others 1will 1tend 1to 1stifle 1the 1conversation 1because 1they 1are 1closed-ended 1questions.
1 Answer 1D 1implies 1negative 1behavior 1and 1may 1also 1keep 1the 1person 1from 1sharing 1freely 1with
1you.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
12. On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual
visit 1for 1her 1blood 1pressure. 1 She 1is 1on 1a 1low-dose 1diuretic 1chronically 1and 1denies 1any 1side
1effects. 1Her 1blood 1pressure 1is 1118/78 1today, 1which 1is 1well-controlled. 1As 1you 1are 1writing 1her
1script, 1she 1mentions 1that 1it 1is 1hard 1not 1having 1her 1husband 1Bill 1around 1anymore. 1What 1would
1you 1do 1next?
A) Hand 1her 1the 1script 1and 1make 1sure 1she 1has 1a 13-month 1follow-up 1appointment.
B) Make 1sure 1she 1understands 1the 1script.
C) Ask 1why 1Bill 1is 1not 1there.
D) Explain 1that 1you 1will 1have 1more 1time 1at 1the 1next 1visit 1to 1discuss 1this.
Ans: 1C
Chapter: 1 03
Feedback: 1Sometimes, 1the 1patient's 1greatest 1need 1is 1for 1support 1and 1empathy. 1It 1would 1be
1inappropriate 1to 1ignore 1this 1comment 1today. 1She 1may 1have 1relied 1heavily 1upon 1Bill 1for 1care
1and 1may 1be 1in 1danger. 1She 1may 1be 1depressed 1and 1even 1suicidal, 1but 1you 1will 1not 1know 1unless
1you 1discuss 1this 1with 1her. 1Most 1importantly, 1you 1should 1empathize 1with 1her 1by 1saying
1something 1like
―It 1must 1be 1very 1difficult 1not 1to 1have 1him 1at 1home‖ 1and 1allow 1a 1pause 1for 1her 1to 1answer.
1 You 1may 1also 1ask 1―What 1did 1you 1rely 1on 1him 1to 1do 1for 1you?‖ 1Only 1a 1life-threatening 1crisis
1with 1another 1patient 1should 1take 1you 1out 1of 1her 1room 1at 1this 1point, 1and 1you 1may 1need 1to
1adjust 1your 1office 1schedule 1to 1allow 1adequate 1time 1for 1her 1today.
13. A 1patient 1is 1describing 1a 1very 1personal 1part 1of 1her 1history 1very 1quickly 1and 1in 1great
1detail. 1How 1should 1you 1react 1to 1this?
A) Write 1down 1as 1much 1as 1you 1can, 1as 1quickly 1as 1possible.
B) Ask 1her 1to 1repeat 1key 1phrases 1or 1to 1pause 1at 1regular 1intervals, 1so 1you 1can 1get 1almost
1every 1word.
C) Tell 1her 1that 1she 1can 1go 1over 1the 1notes 1later 1to 1make 1sure 1they 1are 1accurate.
D) Push 1away 1from 1the 1keyboard 1or 1put 1down 1your 1pen 1and 1listen.
Ans: 1D
Chapter: 1 03
Feedback: 1This 1is 1a 1common 1event 1in 1clinical 1practice. 1It 1is 1much 1more 1important 1to 1listen
1actively 1with 1good 1eye 1contact 1at 1this 1time 1than 1to 1document 1the 1story 1verbatim. 1You 1want 1to
1minimize 1interruption 1(e.g., 1answer 1B). 1 It 1is 1usually 1not 1appropriate 1to 1ask 1a 1patient 1to 1go
1over 1the 1written 1notes, 1but 1it 1would 1be 1a 1good 1idea 1to 1repeat 1the 1main 1ideas 1back 1to 1her. 1You
1should 1be 1certain 1she 1has 1completed 1her 1story 1before 1doing 1this. 1 By 1putting 1down 1your 1pen
1or 1pushing 1away 1from 1the 1keyboard, 1you 1let 1the 1patient 1know 1that 1her 1story 1is 1the 1most
1important 1thing 1to
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
you at this moment.
14. You 1arrive 1at 1the 1bedside 1of 1an 1elderly 1woman 1who 1has 1had 1a 1stroke, 1affecting 1her 1entire
1right 1side. 1She 1cannot 1speak 1(aphasia). 1You 1are 1supposed 1to 1examine 1her. 1 You 1notice 1that
1the 1last 1examiner 1left 1her 1socks 1at 1the 1bottom 1of 1the 1bed, 1and 1although 1sensitive 1areas 1are
1covered 1by 1a 1sheet, 1the 1blanket 1is 1heaped 1by 1her 1feet 1at 1the 1bottom 1of 1the 1bed. 1What 1would
1you 1do 1next?
A) Carry 1out 1your 1examination, 1focusing 1on 1the 1neurologic 1portion, 1and 1then 1cover 1her 1properly.
B) Carry 1out 1your 1examination 1and 1let 1the 1nurse 1assigned 1to 1her 1―put 1her 1back 1together.‖
C) Put 1her 1socks 1back 1on 1and 1cover 1her 1completely 1before 1beginning 1the 1evaluation.
D) Apologize 1for 1the 1last 1examiner 1but 1let 1the 1next 1examiner 1dress 1and 1cover 1her.
Ans: 1C
Chapter: 1 03
Feedback: 1It 1is 1crucial 1to 1make 1an 1effort 1to 1make 1a 1patient 1comfortable. 1In 1this 1scenario, 1the
1patient 1can 1neither 1speak 1nor 1move 1well. 1Take 1a 1moment 1to 1imagine 1yourself 1in 1her
1situation. 1As 1a 1matter 1of 1respect 1as 1well 1as 1comfort, 1you 1should 1cover 1the 1patient
1appropriately 1and 1consider 1returning 1a 1little 1later 1to 1do 1your 1examination 1if 1you 1feel 1she 1is
1cold. 1While 1it 1is 1her 1nurse's 1job 1to 1keep 1her 1comfortable, 1it 1is 1also 1your 1responsibility, 1and
1you 1should 1do 1what 1you 1can. 1 It 1is 1unacceptable 1to 1leave 1the 1patient 1in 1the 1same 1state 1in
1which 1you 1found 1her.
15. When 1you 1enter 1your 1patient's 1examination 1room, 1his 1wife 1is 1waiting 1there 1with 1him.
1 Which 1of 1the 1following 1is 1most 1appropriate?
A) Ask 1if 1it's 1okay 1to 1carry 1out 1the 1visit 1with 1both 1people 1in 1the 1room.
B) Carry 1on 1as 1you 1would 1ordinarily. 1The 1permission 1is 1implied 1because 1his 1wife 1is 1in 1the
1room 1with 1him.
C) Ask 1his 1wife 1to 1leave 1the 1room 1for 1reasons 1of 1confidentiality.
D) First 1ask 1his 1wife 1what 1she 1thinks 1is 1going 1on.
Ans: 1A
Chapter: 1 03
Feedback: 1Even 1in 1situations 1involving 1people 1very 1familiar 1with 1each 1other, 1it 1is 1important 1to
1respect 1individual 1privacy. 1There 1is 1no 1implicit 1consent 1merely 1because 1he 1has 1allowed 1his
1wife 1to 1be 1in 1the 1room 1with 1him. 1On 1the 1other 1hand, 1it 1is 1inappropriate 1to 1assume 1that 1his 1wife
1should 1leave 1the 1room. 1Remember, 1the 1patient 1is 1the 1focus 1of 1the 1visit, 1so 1it 1would 1be
1appropriate 1to 1allow 1him 1to 1control 1who 1is 1in 1the 1room 1with 1him 1and 1 inappropriate 1to 1address
1his 1wife 1first.
Although 1your 1duty 1is 1to 1the 1patient, 1you 1may 1get 1optimal 1information 1by 1offering 1to 1speak 1to
1both 1people 1confidentially. 1 This 1situation 1is 1analogous 1to 1an 1adolescent's 1visit.
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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 1much 1pain 1are 1you 1having?
B) Have 1you 1injured 1this 1knee 1in 1the 1past?
C) When 1did 1this 1first 1occur?
D) Could 1you 1please 1describe 1what 1happened?
Ans: 1D
Chapter: 1 03
Feedback: 1When 1looking 1into 1a 1complaint, 1it 1is 1best 1to 1start 1with 1an 1invitation 1for 1the 1patient
1to 1tell 1you 1in 1his 1or 1her 1own 1words. 1 More 1specific 1questions 1should 1be 1used 1later 1in 1the
1interview 1to 1fill 1in 1any 1gaps.
17. You 1have 1just 1asked 1a 1patient 1how 1he 1feels 1about 1his 1emphysema. 1He 1becomes 1silent,
1folds 1his 1arms 1across 1his 1chest 1and 1leans 1back 1in 1his 1chair, 1and 1then 1replies, 1―It 1is 1what 1it
1is.‖ 1How 1should 1you 1respond?
A) ―You 1seem 1bothered 1by 1this 1question.‖
B) ―Next, 1I 1would 1like 1to 1talk 1with 1you 1about 1your 1smoking 1habit.‖
C) ―Okay, 1let's 1move 1on 1to 1your 1other 1problems.‖
D) ―You 1have 1adopted 1a 1practical 1attitude 1toward 1your 1problem.‖
Ans: 1A
Chapter: 1 03
Feedback: 1You 1have 1astutely 1noted 1that 1the 1patient's 1body 1language 1changed 1at 1the 1time 1you
1asked 1this 1question, 1and 1despite 1the 1patient's 1response, 1you 1suspect 1there 1is 1more 1beneath 1the
1surface. 1Maybe 1he 1is 1afraid 1of 1being 1browbeaten 1about 1his 1smoking, 1maybe 1a 1relative 1has
1recently 1died 1from 1this 1disorder, 1or 1maybe 1a 1friend 1told 1him 120 1years 1ago 1that 1he 1would
1eventually 1get 1emphysema. 1Regardless, 1by 1sharing 1your 1observation 1and 1leaving 1a 1pause, 1he
1may 1begin 1to 1talk 1about 1some 1issues 1which 1are 1very 1important 1to 1him.
18. A 1patient 1tells 1you 1about 1her 1experience 1with 1prolonged 1therapy 1for 1her 1breast 1cancer.
1You 1comment, 1―That 1must 1have 1been 1a 1very 1trying 1time 1for 1you.‖ 1 What 1is 1this 1an 1example
1of?
A) Reassurance
B) Empathy
C) Summarization
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
D) Validation
Ans: D
Chapter: 03
Feedback: 1This 1is 1an 1example 1of 1validation 1to 1legitimize 1her 1emotional 1experience. 1―Now
1that 1you 1have 1had 1your 1treatment, 1you 1should 1not 1have 1any 1further 1troubles‖ 1is 1an 1example 1of
1reassurance. 1―I 1understand 1what 1you 1went 1through 1because 1I 1am 1a 1cancer 1survivor 1myself‖ 1is
1an 1example 1of 1empathy. 1―So, 1you 1have 1had 1a 1lumpectomy 1and 1multiple 1radiation 1treatments‖
1is 1an 1example 1of 1summarization 1as 1applied 1to 1this 1vignette.
19. You 1are 1performing 1a 1young 1woman's 1first 1pelvic 1examination. 1You 1make 1sure 1to 1tell
1her 1verbally 1what 1is 1coming 1next 1and 1what 1to 1expect. 1Then 1you 1carry 1out 1each 1maneuver 1of
1the 1examination. 1You 1let 1her 1know 1at 1the 1outset 1that 1if 1she 1needs 1a 1break 1or 1wants 1to 1stop,
1this 1is 1possible. 1You 1ask 1several 1times 1during 1the 1examination, 1―How 1are 1you 1doing,
1Brittney?‖ 1What 1are 1you 1accomplishing 1with 1these 1techniques?
A) Increasing 1the 1patient's 1sense 1of 1control
B) Increasing 1the 1patient's 1trust 1in 1you 1as 1a 1caregiver
C) Decreasing 1her 1sense 1of 1vulnerability
D) All 1of 1the 1above
Ans: 1D
Chapter: 1 03
Feedback: 1These 1techniques 1minimize 1the 1effects 1of 1transitions 1during 1an 1examination
1and 1empower 1the 1patient. 1Especially 1during 1a 1sensitive 1examination, 1it 1is 1important 1to
1give 1the 1patient 1as 1much 1control 1as 1possible.
20. When 1using 1an 1interpreter 1to 1facilitate 1an 1interview, 1where 1should 1the 1interpreter
1be 1positioned?
A) Behind 1you, 1the 1examiner, 1so 1that 1the 1lips 1of 1the 1patient 1and 1the 1patient's 1nonverbal 1cues
1can 1be 1seen
B) Next 1to 1the 1patient, 1so 1the 1examiner 1can 1maintain 1eye 1contact 1and 1observe 1the 1nonverbal
1cues 1of 1the 1patient
C) Between 1you 1and 1the 1patient 1so 1all 1parties 1can 1make 1the 1necessary 1observations
D) In 1a 1corner 1of 1the 1room 1so 1as 1to 1provide 1minimal 1distraction 1to 1the 1interview
Ans: 1B
Feedback: 1 Interpreters 1are 1invaluable 1in 1encounters 1where 1the 1examiner 1and 1patient 1do 1not 1speak
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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.
1
Chapter 1 4 1 The 1 Health 1 History
Multiple 1Choice
1. A 115-year-old 1high 1school 1sophomore 1and 1her 1mother 1come 1to 1your 1clinic 1because 1the
1mother 1is 1concerned 1about 1her 1daughter's 1weight. 1You 1measure 1her 1daughter's 1height 1and
2
1weight 1and 1obtain 1a 1BMI 1of 119.5 1kg/m . 1Based 1on 1this 1information, 1which 1of 1the 1following 1is
1appropriate?
A) Refer 1the 1patient 1to 1a 1nutritionist 1and 1a 1psychologist 1because 1the 1patient 1is 1anorexic.
B) Reassure 1the 1mother 1that 1this 1is 1a 1normal 1body 1weight.
C) Give 1the 1patient 1information 1about 1exercise 1because 1the 1patient 1is 1obese.
D) Give 1the 1patient 1information 1concerning 1reduction 1of 1fat 1and 1cholesterol 1in 1her 1diet
1because 1she 1is 1obese.
Ans: 1B
Chapter: 1 04
Feedback: 1The 1patient 1has 1a 1normal 1BMI; 1the 1range 1for 1a 1normal 1BMI 1is 118.5 1to 124.9 1kg/m2.
1You 1may 1be 1able 1to 1give 1the 1patient 1and 1her 1mother 1the 1lower 1limit 1of 1normal 1in 1pounds 1for
1her 1daughter's 1height, 1or 1instruct 1her 1in 1how 1to 1use 1a 1BMI 1table.
2. A 125-year-old 1radio 1announcer 1comes 1to 1the 1clinic 1for 1an 1annual 1examination. 1His 1BMI 1is
26.0 1kg/m2. 1He 1is 1concerned 1about 1his 1weight. 1Based 1on 1this 1information, 1what 1is 1appropriate
1counsel 1for 1the 1patient 1during 1the 1visit?
A) Refer 1the 1patient 1to 1a 1nutritionist 1because 1he 1is 1anorexic.
B) Reassure 1the 1patient 1that 1he 1has 1a 1normal 1body 1weight.
C) Give 1the 1patient 1information 1about 1reduction 1of 1fat, 1cholesterol, 1and 1calories 1because 1he
1is 1overweight.
D) Give 1the 1patient 1information 1about 1reduction 1of 1fat 1and 1cholesterol 1because 1he 1is 1obese.
Ans: 1C
Chapter: 1 04
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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 130-year-old 1sales 1clerk 1comes 1to 1your 1office 1wanting 1to 1lose 1weight; 1her 1BMI 1is 130.0
2
1kg/m . 1What 1is 1the 1most 1appropriate 1amount 1for 1a 1weekly 1weight 1reduction 1goal?
A) .5 1to 11 1pound 1per 1week
B) 1 1to 12.5 1pounds 1per 1week
C) 2.5 1to 13.5 1pounds 1per 1week
D) 3.5 1to 14.5 1pounds 1per 1week
Ans: 1A
Chapter: 1 04
Feedback: 1 Based 1on 1the 1NIH 1Obesity 1Guidelines, 1this 1is 1the 1weekly 1weight 1loss 1goal 1to 1strive
1for 1to 1maintain 1long-term 1control 1of 1weight. 1More 1rapid 1weight 1loss 1than 1this 1does 1not 1result
1in 1a 1better 1outcome 1at 1one 1year.
4. A 167-year-old 1retired 1janitor 1comes 1to 1the 1clinic 1with 1his 1wife. 1She 1brought 1him 1in 1because
1 she 1is 1concerned 1about 1his 1weight 1loss. 1He 1has 1a 1history 1of 1smoking 13 1packs 1of 1cigarettes 1a
1day 1for 130 1years, 1for 1a 1total 1of 190 1pack-years. 1He 1has 1noticed 1a 1daily 1cough 1for 1the 1past
1several 1years, 1which 1he 1states 1is 1productive 1of 1sputum. 1He 1came 1into 1the 1clinic 1approximately 11
1year 1ago, 1and 1at 1that 1time 1his 1weight 1was 1140 1pounds. 1Today, 1his 1weight 1is 1110 1pounds.
Which 1one 1of 1the 1following 1questions 1would 1be 1the 1most 1important 1to 1ask 1if 1you 1suspect 1that
1he 1has 1lung 1cancer?
A) Have 1you 1tried 1to 1force 1yourself 1to 1vomit 1after 1eating 1a 1meal?
B) Do 1you 1have 1heartburn/indigestion 1and 1diarrhea?
C) Do 1you 1have 1enough 1food 1to 1eat?
D) Have 1you 1tried 1to 1lose 1weight?
Ans: 1D
Chapter: 1 04
Feedback: 1This 1is 1important: 1If 1the 1patient 1hasn't 1tried 1to 1lose 1weight, 1then 1this 1weight 1loss 1is
1inadvertent 1and 1poses 1concern 1for 1a 1neoplastic 1process, 1especially 1given 1his 1smoking 1history.
5. Common 1or 1concerning 1symptoms 1to 1inquire 1about 1in 1the 1General 1Survey 1and 1vital 1signs
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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: 1C
Chapter: 1 04
Feedback: 1 This 1symptom 1is 1more 1appropriate 1to 1the 1respiratory 1review 1of 1systems.
6. You 1are 1beginning 1the 1examination 1of 1a 1patient. 1All 1of 1the 1following 1areas 1are 1important
1to 1observe 1as 1part 1of 1the 1General 1Survey 1except:
A) Level 1of 1consciousness
B) Signs 1of 1distress
C) Dress, 1grooming, 1and 1personal 1hygiene
D) Blood 1pressure
Ans: 1D
Chapter: 1 04
Feedback: 1 Blood 1pressure 1is 1a 1vital 1sign, 1not 1part 1of 1the 1General 1Survey.
7. A 155-year-old 1bookkeeper 1comes 1to 1your 1office 1for 1a 1routine 1visit. 1You 1note 1that 1on 1a
1previous 1visit 1for 1treatment 1of 1contact 1dermatitis, 1her 1blood 1pressure 1was 1elevated. 1She 1does
1not 1have 1prior 1elevated 1readings 1and 1her 1family 1history 1is 1negative 1for 1hypertension. 1You
1measure 1her 1blood 1pressure 1in 1your 1office 1today. 1Which 1of 1the 1following 1factors 1can 1result 1in
1a 1false 1high 1reading?
A) Blood 1pressure 1cuff 1is 1tightly 1fitted.
B) Patient 1is 1seated 1quietly 1for 110 1minutes 1prior 1to 1measurement.
C) Blood 1pressure 1is 1measured 1on 1a 1bare 1arm.
D) Patient's 1arm 1is 1resting, 1supported 1by 1your 1arm 1at 1her 1mid-chest 1level 1as 1you 1stand 1to
1measure 1the 1blood 1pressure.
Ans: 1A
Chapter: 1 04
Feedback: 1A 1blood 1pressure 1cuff 1that 1is 1too 1tightly 1fitted 1can 1result 1in 1a 1false 1high 1reading.
1The 1other 1answers 1are 1important 1to 1observe 1to 1obtain 1an 1accurate 1blood 1pressure 1reading.
1JNC-7 1also 1mentions 1the 1importance 1of 1having 1the 1back 1supported 1when 1obtaining 1blood
1pressure 1in 1the
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sitting position.
8. A 149-year-old 1truck 1driver 1comes 1to 1the 1emergency 1room 1for 1shortness 1of 1breath 1and
1swelling 1in 1his 1ankles. 1He 1is 1diagnosed 1with 1congestive 1heart 1failure 1and 1admitted 1to 1the
1hospital. 1You 1are 1the 1student 1assigned 1to 1do 1the 1patient's 1complete 1history 1and 1physical
1examination. 1When 1you 1palpate 1the 1pulse, 1what 1do 1you 1expect 1to 1feel?
A) Large 1amplitude, 1forceful
B) Small 1amplitude, 1weak
C) Normal
D) Bigeminal
Ans: 1B
Chapter: 1 04
Feedback: 1Congestive 1heart 1failure 1is 1characterized 1by 1decreased 1stroke 1volume 1or 1increased
1peripheral 1vascular 1resistance, 1which 1would 1result 1in 1a 1small-amplitude, 1weak 1pulse. 1Subtle
1differences 1in 1amplitude 1are 1usually 1best 1detected 1in 1large 1arteries 1close 1to 1the 1heart, 1like 1the
1carotid 1pulse. 1 You 1may 1not 1be 1able 1to 1notice 1these 1in 1other 1locations.
9. An 118-year-old 1college 1freshman 1presents 1to 1the 1clinic 1for 1evaluation 1of 1gastroenteritis. 1You
1measure 1the 1patient's 1temperature 1and 1it 1is 1104 1degrees 1Fahrenheit. 1What 1type 1of 1pulse 1would
1you 1expect 1to 1feel 1during 1his 1initial 1examination?
A) Large 1amplitude, 1forceful
B) Small 1amplitude, 1weak
C) Normal
D) Bigeminal
Ans: 1A
Chapter: 1 04
Feedback: 1Fever 1results 1in 1an 1increased 1stroke 1volume, 1which 1results 1in 1a 1large-amplitude,
1forceful 1pulse. 1 Later 1in 1the 1course 1of 1the 1illness, 1if 1dehydration 1and 1shock 1result, 1you 1may
1expect 1small 1amplitude 1and 1weak 1pulses.
10. A 125-year-old 1type 11 1diabetic 1clerk 1presents 1to 1the 1emergency 1room 1with 1shortness 1of
1breath 1and 1states 1that 1his 1blood 1sugar 1was 1605 1at 1home. 1You 1diagnose 1the 1patient 1with
1diabetic 1ketoacidosis. 1What 1is 1the 1expected 1pattern 1of 1breathing?
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A) Normal
B) Rapid and shallow
C) Rapid and deep
D) Slow
Ans: 1C
Chapter: 1 04
Feedback: 1This 1is 1the 1expected 1rate 1and 1depth 1in 1diabetic 1ketoacidosis. 1The 1body 1is 1trying 1to
1rid 1itself 1of 1carbon 1dioxide 1to 1compensate 1for 1the 1acidosis. 1This 1is 1known 1as 1Kussmaul's
1breathing 1and 1is 1seen 1in 1other 1causes 1of 1acidosis 1as 1well.
11. Mrs. 1Lenzo 1weighs 1herself 1every 1day 1with 1a 1very 1accurate 1balance-type 1scale. 1She 1has
1noticed 1that 1over 1the 1past 12 1days 1she 1has 1gained 14 1pounds. 1 How 1would 1you 1best 1explain
1this?
A) Attribute 1this 1to 1some 1overeating 1at 1the 1holidays.
B) Attribute 1this 1to 1wearing 1different 1clothing.
C) Attribute 1this 1to 1body 1fluid.
D) Attribute 1this 1to 1instrument 1inaccuracy.
Ans: 1C
Chapter: 1 04
Feedback: 1This 1amount 1of 1weight 1over 1a 1short 1period 1should 1make 1one 1think 1of 1body 1fluid
1changes. 1You 1may 1consider 1a 1kidney 1problem 1or 1heart 1failure 1in 1your 1differential. 1The 1other
1reasons 1should 1be 1considered 1as 1well, 1but 1this 1amount 1of 1weight 1gain 1over 1a 1short 1period
1usually 1indicates 1causes 1other 1than 1excessive 1caloric 1intake. 1A 1rule 1of 1thumb 1for 1dieters 1is 1that
1an 1energy 1excess 1of 13500 1calories 1will 1cause 1a 11-pound 1weight 1gain, 1if 1the 1increase 1is 1to 1be
1attributed 1to 1food 1intake.
12. Mr. 1Curtiss 1has 1a 1history 1of 1obesity, 1diabetes, 1osteoarthritis 1of 1the 1knees, 1HTN, 1and
1obstructive 1sleep 1apnea. 1His 1BMI 1is 143 1and 1he 1has 1been 1discouraged 1by 1his 1difficulty 1in
1losing 1weight. 1He 1is 1also 1discouraged 1that 1his 1goal 1weight 1is 1158 1pounds 1away. 1What
1would 1you 1tell 1him?
A) ―When 1you 1get 1down 1to 1your 1goal 1weight, 1you 1will 1feel 1so 1much 1better.‖
B) ―Some 1people 1seem 1to 1be 1able 1to 1lose 1weight 1and 1others 1just 1can't, 1no 1matter 1how 1hard
1they 1try.‖
C) ―We 1are 1coming 1up 1with 1new 1medicines 1and 1methods 1to 1treat 1your 1conditions 1every 1day.‖
D) ―Even 1a 1weight 1loss 1of 110% 1can 1make 1a 1noticeable 1improvement 1in 1the 1problems 1you
1mention.‖
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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 1find 1it 1empowering 1to 1know 1that 1they 1can 1achieve 1a 1small 1goal, 1such 1as 1a 1loss 1of 11
1pound 1per 1week. 1They 1must 1be 1reminded 1that 1this 1process 1will 1take 1time 1and 1that 1slow 1weight
1loss 1is 1more 1successful 1long-term. 1Research 1has 1shown 1that 1significant 1benefits 1often 1come
1with 1even 1a 110% 1weight 1loss.
13. Jenny 1is 1one 1of 1your 1favorite 1patients 1who 1usually 1shares 1a 1joke 1with 1you 1and 1is
1nattily 1dressed. 1Today 1she 1is 1dressed 1in 1old 1jeans, 1lacks 1makeup, 1and 1avoids 1eye 1contact.
1To 1what 1do 1you 1attribute 1these 1changes?
A) She 1is 1lacking 1sleep.
B) She 1is 1fatigued 1from 1work.
C) She 1is 1running 1into 1financial 1difficulty.
D) She 1is 1depressed.
Ans: 1D
Chapter: 1 04
Feedback: 1It 1is 1important 1to 1use 1all 1of 1your 1skills 1and 1memory 1of 1an 1individual 1patient 1to
1guide 1your 1thought 1process. 1She 1is 1not 1described 1as 1sleepy. 1Work 1fatigue 1would 1most 1likely
1not 1cause 1avoidance 1of 1eye 1contact. 1 Financial 1difficulties 1would 1not 1necessarily 1deplete 1a
1nice 1wardrobe. 1It 1is 1most 1likely 1that 1she 1is 1depressed 1or 1in 1another 1type 1of 1difficulty.
14. You 1are 1seeing 1an 1older 1patient 1who 1has 1not 1had 1medical 1care 1for 1many 1years. 1Her 1vital
1signs 1taken 1by 1your 1office 1staff 1are: 1T 137.2, 1HR 178, 1BP 1118/92, 1and 1RR 114, 1and 1she 1denies
1pain. 1You 1notice 1that 1she 1has 1some 1hypertensive 1changes 1in 1her 1retinas 1and 1you 1find 1mild
1proteinuria 1on 1a 1urine 1test 1in 1your 1office. 1 You 1expected 1the 1BP 1to 1be 1higher. 1 She 1is 1not 1on
1any 1medications. 1What 1do 1you 1think 1is 1causing 1this 1BP 1reading, 1which 1doesn't 1correlate 1with
1the 1other 1findings?
A) It 1is 1caused 1by 1an 1―auscultatory 1gap.‖
B) It 1is 1caused 1by 1a 1cuff 1size 1error.
C) It 1is 1caused 1by 1the 1patient's 1emotional 1state.
D) It 1is 1caused 1by 1resolution 1of 1the 1process 1which 1caused 1her 1retinopathy 1and 1kidney 1problems.
Ans: 1A
Chapter: 1 04
Feedback: 1 The 1blood 1pressure 1is 1unusual 1in 1this 1case 1in 1that 1the 1systolic 1pressure 1is 1normal 1while
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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 1caused 1the 1retinopathy 1and 1kidney 1problems 1may 1have 1resolved, 1leaving 1these 1findings,
1it 1is 1a 1dangerous 1assumption 1that 1this 1is 1the 1sole 1cause 1of 1the 1problems 1seen 1in 1this 1patient.
15. Despite 1having 1high 1BP 1readings 1in 1the 1office, 1Mr. 1Kelly 1tells 1you 1that 1his 1readings 1at
1home 1are 1much 1lower. 1He 1checks 1them 1twice 1a 1day 1at 1the 1same 1time 1of 1day 1and 1has 1kept 1a
1log. 1How 1do 1you 1respond?
A) You 1diagnose 1―white 1coat 1hypertension.‖
B) You 1assume 1he 1is 1quite 1nervous 1when 1he 1comes 1to 1your 1office.
C) You 1question 1the 1accuracy 1of 1his 1measurements.
D) You 1question 1the 1accuracy 1of 1your 1measurements.
Ans: 1C
Chapter: 1 04
Feedback: 1 It 1is 1not 1uncommon 1to 1see 1differences 1in 1a 1patient's 1home 1measurements 1and 1your
1own 1in 1the 1office. 1 Presuming 1that 1this 1is 1―white 1coat 1hypertension‖ 1can 1be 1dangerous
1because 1this 1condition 1is 1not 1usually 1treated. 1This 1allows 1for 1the 1effects 1of 1a 1missed 1diagnosis
1of 1hypertension 1to 1go 1unchecked. 1It 1is 1also 1very 1difficult 1to 1judge 1if 1a 1patient 1is 1outwardly
1nervous. 1You 1should 1always 1consider 1that 1your 1measurements 1are 1not 1accurate 1as 1well, 1but
1the 1fact 1that 1you 1and 1your 1staff 1are 1well-trained 1and 1perform 1this 1procedure 1on 1hundreds 1of
1patients 1a 1week 1makes 1this 1less 1likely. 1Ideally, 1you 1would 1ask 1the 1patient 1to 1bring 1in 1his 1BP
1equipment 1and 1take 1a 1simultaneous 1reading 1with 1you 1to 1make 1sure 1that 1he 1is 1getting 1an
1accurate 1reading.
16. You 1are 1observing 1a 1patient 1with 1heart 1failure 1and 1notice 1that 1there 1are 1pauses 1in 1his
1breathing. 1On 1closer 1examination, 1you 1notice 1that 1after 1the 1pauses 1the 1patient 1takes
1progressively 1deeper 1breaths 1and 1then 1progressively 1shallower 1breaths, 1which 1are 1followed 1by
1another 1apneic 1spell. 1 The 1patient 1is 1not 1in 1any 1distress. 1 You 1make 1the 1diagnosis 1of:
A) Ataxic 1(Biot's) 1breathing
B) Cheyne-Stokes 1respiration
C) Kussmaul's 1respiration
D) COPD 1with 1prolonged 1expiration
Ans: 1B
Chapter: 1 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. 1Garcia 1comes 1to 1your 1office 1for 1a 1rash 1on 1his 1chest 1associated 1with 1a 1burning 1pain.
1Even 1a 1light 1touch 1causes 1this 1burning 1sensation 1to 1worsen. 1 On 1examination, 1you 1note 1a 1rash
1with 1small 1blisters 1(vesicles) 1on 1a 1background 1of 1reddened 1skin. 1The 1rash 1overlies 1an 1entire
1rib 1on 1his 1right 1side. 1 What 1type 1of 1pain 1is 1this?
A) Idiopathic 1pain
B) Neuropathic 1pain
C) Nociceptive 1or 1somatic 1pain
D) Psychogenic 1pain
Ans: 1B
Chapter: 1 04
Feedback: 1This 1vignette 1is 1consistent 1with 1a 1diagnosis 1of 1herpes 1zoster, 1or 1shingles. 1This 1is
1caused 1by 1reemergence 1of 1dormant 1varicella 1(chickenpox) 1viruses 1from 1Mr. 1Garcia's 1nerve
1root. 1The 1characteristic 1burning 1quality 1without 1a 1history 1of 1an 1actual 1burn 1makes 1one 1think
1of 1neuropathic 1pain. 1It 1will 1most 1likely 1remain 1for 1months 1after 1the 1rash 1has 1resolved. 1There
1is 1no 1evidence 1of 1physical 1injury 1and 1this 1is 1a 1peculiar 1distribution, 1making 1nociceptive 1pain
1less 1likely. 1There 1is 1no 1evidence 1of 1a 1psychogenic 1etiology 1for 1this, 1and 1the 1presence 1of 1a 1rash
1makes 1this 1possibility 1less 1likely 1as 1well. 1Because 1of 1your 1astute 1diagnostic 1abilities, 1the 1pain
1is 1not 1idiopathic.
18. A 150-year-old 1body 1builder 1is 1upset 1by 1a 1letter 1of 1denial 1from 1his 1life 1insurance
1company. 1He 1is 1very 1lean 1but 1has 1gained 12 1pounds 1over 1the 1past 16 1months. 1You 1personally
1performed 1his 1health 1assessment 1and 1found 1no 1problems 1whatsoever. 1He 1says 1he 1is
1classified 1as 1―high 1risk‖ 1because 1of 1obesity. 1 What 1should 1you 1do 1next?
A) Explain 1that 1even 1small 1amounts 1of 1weight 1gain 1can 1classify 1you 1as 1obese.
B) Place 1him 1on 1a 1high-protein, 1low-fat 1diet.
C) Advise 1him 1to 1increase 1his 1aerobic 1exercise 1for 1calorie 1burning.
D) Measure 1his 1waist.
Ans: 1D
Chapter: 1 04
Feedback: 1 The 1patient 1most 1likely 1had 1a 1high 1BMI 1because 1of 1increased 1muscle 1mass. 1 In 1this
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
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. 1Wright 1comes 1to 1your 1office, 1complaining 1of 1palpitations. 1 While 1checking 1her 1pulse
1you 1notice 1an 1irregular 1rhythm. 1When 1you 1listen 1to 1her 1heart, 1every 1fourth 1beat 1sounds
1different. 1It 1sounds 1like 1a 1triplet 1rather 1than 1the 1usual 1―lub 1dup.‖ 1How 1would 1you 1document
1your 1examination?
A) Regular 1rate 1and 1rhythm
B) Irregularly 1irregular 1rhythm
C) Regularly 1irregular 1rhythm
D) Bradycardia
Ans: 1C
Chapter: 1 04
Feedback: 1Because 1this 1unusual 1beat 1occurs 1every 1fourth 1set 1of 1heart 1sounds, 1it 1is 1regularly
1irregular. 1This 1is 1most 1consistent 1with 1ventricular 1premature 1contractions 1(or 1VPCs). 1This 1is
1generally 1a 1common 1and 1benign 1rhythm. 1An 1irregularly 1irregular 1rhythm 1is 1a 1classic 1finding
1in 1atrial 1fibrillation. 1The 1rhythm 1is 1very 1random 1in 1character. 1Bradycardia 1refers 1to 1the 1rate,
1not 1the 1rhythm.
Chapter 15 1 Cultural 1and 1Spiritual 1Assessment
1
MULTIPLE 1CHOICE
1. The 1nurse 1is 1reviewing 1the 1development 1of 1culture. 1Which 1statement 1is 1correct 1regarding
the 1development 1of 1ones 1culture? 1Culture 1is:
1
a. Genetically 1determined 1on 1the 1basis 1of 1racial 1background.
b. Learned 1through 1language 1acquisition 1and 1socialization.
c. A 1nonspecific 1phenomenon 1and 1is 1adaptive 1but 1unnecessary.
d. Biologically 1determined 1on 1the 1basis 1of 1physical 1characteristics.
ANS: 1B
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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. 1Which 1statement 1correctly 1reflects 1one 1of 1these 1characteristics?
a. Cultures 1are 1static 1and 1unchanging, 1despite 1changes 1around 1them.
b. Cultures 1are 1never 1specific, 1which 1makes 1them 1hard 1to 1identify.
c. Culture 1is 1most 1clearly 1reflected 1in 1a 1persons 1language 1and 1behavior.
d. Culture 1adapts 1to 1specific 1environmental 1factors 1and 1available 1natural 1resources.
ANS: 1D
Culture 1has 1four 1basic 1characteristics. 1Culture 1adapts 1to 1specific 1conditions 1related 1to
1
environmental 1and 1technical 1factors 1and 1to 1the 1availability 1of 1natural 1resources, 1and 1it 1is
dynamic 1and 1ever 1changing. 1Culture 1is 1learned 1from 1birth 1through 1the 1process 1of 1language
1
acquisition 1and 1socialization, 1but 1it 1is 1not 1most 1clearly 1reflected 1in 1ones 1language 1and
1
1
behavior.
3. During 1a 1seminar 1on 1cultural 1aspects 1of 1nursing, 1the 1nurse 1recognizes 1that 1the 1definition
stating 1the 1specific 1and 1distinct 1knowledge, 1beliefs, 1skills, 1and 1customs 1acquired 1by 1members
1
1
of 1a 1society 1reflects 1which 1term?
a. Mores
b. Norms
c. Culture
d. Social 1learning
ANS: 1C
The 1culture 1that 1develops 1in 1any 1given 1society 1is 1always 1specific 1and 1distinctive,
1
encompassing 1all 1of 1the 1knowledge, 1beliefs, 1customs, 1and 1skills 1acquired 1by 1members 1of 1the
society. 1The 1other 1terms 1do 1not 1fit 1the 1given 1definition.
1
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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 1small 1groups 1of 1people 1who 1do 1not 1want 1to 1be 1identified 1with 1the
1larger 1culture.
c. Singling 1out 1groups 1of 1people 1who 1suffer 1differential 1and 1unequal 1treatment 1as
1a 1result 1of 1cultural 1variations.
d. Identifying 1fairly 1large 1groups 1of 1people 1with 1shared 1characteristics 1that 1are
1not 1common 1to 1all 1members 1of 1a 1culture.
ANS: 1D
Within 1cultures, 1groups 1of 1people 1share 1different 1beliefs, 1values, 1and 1attitudes. 1Differences
occur 1because 1of 1ethnicity, 1religion, 1education, 1occupation, 1age, 1and 1gender. 1When 1such
1
1
groups 1function 1within 1a 1large 1culture, 1they 1are 1referred 1to 1as 1subcultural 1groups.
5. When 1reviewing 1the 1demographics 1of 1ethnic 1groups 1in 1the 1United 1States, 1the 1nurse 1recalls
that 1the 1largest 1and 1fastest 1growing 1population 1is:
1
a. Hispanic.
b. Black.
c. Asian.
d. American 1Indian.
ANS: 1A
Hispanics 1are 1the 1largest 1and 1fastest 1growing 1population 1in 1the 1United 1States, 1followed 1by
1
Asians, 1Blacks, 1American 1Indians 1and 1Alaska 1natives, 1and 1other 1groups.
6. During 1an 1assessment, 1the 1nurse 1notices 1that 1a 1patient 1is 1handling 1a 1small 1charm 1that 1is 1tied
to 1a 1leather 1strip 1around 1his 1neck. 1Which 1action 1by 1the 1nurse 1is 1appropriate?
1
a. Ask 1the 1patient 1about 1the 1item 1and 1its 1significance.
b. Ask 1the 1patient 1to 1lock 1the 1item 1with 1other 1valuables 1in 1the 1hospitals 1safe.
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c. Tell the patient that a family member should take valuables home.
d. No action is necessary.
ANS: 1A
The 1nurse 1should 1inquire 1about 1the 1amulets 1meaning. 1Amulets, 1such 1as 1charms, 1are 1often
1
considered 1an 1important 1means 1of 1protection 1from 1evil 1spirits 1by 1some 1cultures.
7. The 1nurse 1manager 1is 1explaining 1culturally 1competent 1care 1during 1a 1staff 1meeting.
Which 1statement 1accurately 1describes 1the 1concept 1of 1culturally 1competent 1care? 1The
1
1
caregiver:
a. Is 1able 1to 1speak 1the 1patients 1native 1language.
b. Possesses 1some 1basic 1knowledge 1of 1the 1patients 1cultural 1background.
c. Applies 1the 1proper 1background 1knowledge 1of 1a 1patients 1cultural 1background
1to 1provide 1the 1best 1possible 1health 1care.
d. Understands 1and 1attends 1to 1the 1total 1context 1of 1the 1patients 1situation.
ANS: 1D
Culturally 1competent 1implies 1that 1the 1caregiver 1understands 1and 1attends 1to 1the 1total 1context 1of 1the
1
individuals 1situation. 1This 1competency 1includes 1awareness 1of 1immigration 1status, 1stress 1factors,
1
other 1social 1factors, 1and 1cultural 1similarities 1and 1differences. 1It 1does 1not 1require 1the 1caregiver 1to
1
speak 1the 1patients 1native 1language.
8. The 1nurse 1recognizes 1that 1an 1example 1of 1a 1person 1who 1is 1heritage 1consistent 1would 1be 1a:
a. Woman 1who 1has 1adapted 1her 1clothing 1to 1the 1clothing 1style 1of 1her 1new 1country.
b. Woman 1who 1follows 1the 1traditions 1that 1her 1mother 1followed 1regarding 1meals.
c. Man 1who 1is 1not 1sure 1of 1his 1ancestors 1country 1of 1origin.
d. Child 1who 1is 1not 1able 1to 1speak 1his 1parents 1native 1language.
ANS: 1B
Someone 1who 1is 1heritage 1consistent 1lives 1a 1lifestyle 1that 1reflects 1his 1or 1her 1traditional 1heritage,
1
not 1the 1norms 1and 1customs 1of 1the 1new 1country.
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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 1is 1the 1belief 1in 1a 1higher 1power.
c. Ethnicity 1pertains 1to 1a 1social 1group 1within 1the 1social 1system 1that 1claims
1shared 1values 1and 1traditions.
d. Ethnicity 1is 1learned 1from 1birth 1through 1the 1processes 1of 1language 1acquisition
1and 1socialization.
ANS: 1C
Ethnicity 1pertains 1to 1a 1social 1group 1within 1the 1social 1system 1that 1claims 1to 1have 1variable
1
traits, 1such 1as 1a 1common 1geographic 1origin, 1migratory 1status, 1religion, 1race, 1language, 1values,
1
traditions, 1symbols, 1or 1food 1preferences.Culture 1is 1dynamic, 1ever 1changing, 1and 1learned 1from
1
birth 1through 1the 1processes 1of 1language 1acquisition 1and 1socialization. 1Religion 1is 1the 1belief 1in
a 1higher 1power.
1
10. The 1nurse 1is 1comparing 1the 1concepts 1of 1religion 1and 1spirituality. 1Which 1of 1the 1following 1is
an 1appropriate 1component 1of 1ones 1spirituality?
1
a. Belief 1in 1and 1the 1worship 1of 1God 1or 1gods
b. Attendance 1at 1a 1specific 1church 1or 1place 1of 1worship
c. Personal 1effort 1made 1to 1find 1purpose 1and 1meaning 1in 1life
d. Being 1closely 1tied 1to 1ones 1ethnic 1background
ANS: 1C
Spirituality 1refers 1to 1each 1persons 1unique 1life 1experiences 1and 1his 1or 1her 1personal 1effort 1to 1find
1
purpose 1and 1meaning 1in 1life. 1The 1other 1responses 1apply 1to 1religion.
11. A 1woman 1who 1has 1lived 1in 1the 1United 1States 1for 1a 1year 1after 1moving 1from 1Europe 1has
learned 1to 1speak 1English 1and 1is 1almost 1finished 1with 1her 1college 1studies. 1She 1now 1dresses 1like
1
1
her 1peers 1and 1says 1that 1her 1family 1in 1Europe 1would 1hardly 1recognize 1her. 1This 1nurse
1
recognizes 1that 1this 1situation 1illustrates 1which 1concept?
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a. Assimilation
b. Heritage consistency
c. Biculturalism
d. 1 Acculturation
ANS: 1A
Assimilation 1is 1the 1process 1by 1which 1a 1person 1develops 1a 1new 1cultural 1identity 1and 1becomes 1like
1
members 1of 1the 1dominant 1culture. 1This 1concept 1does 1not 1reflect 1heritage 1consistency.
Biculturalism 1is 1a 1dual 1pattern 1of 1identification; 1acculturation 1is 1the 1process 1of 1adapting 1to 1and
1
acquiring 1another 1culture.
12. The 1nurse 1is 1conducting 1a 1heritage 1assessment. 1Which 1question 1is 1most 1appropriate 1for
this 1assessment?
1
a. What 1is 1your 1religion?
b. Do 1you 1mostly 1participate 1in 1the 1religious 1traditions 1of 1your 1family?
c. Do 1you 1smoke?
d. Do 1you 1have 1a 1history 1of 1heart 1disease?
ANS: 1B
Asking 1questions 1about 1participation 1in 1the 1religious 1traditions 1of 1family 1enables 1the 1nurse 1to
1
assess 1a 1persons 1heritage. 1Simply 1asking 1about 1ones 1religion, 1smoking 1history, 1or 1health
history 1does 1not 1reflect 1heritage.
1
13. In 1the 1majority 1culture 1of 1America, 1coughing, 1sweating, 1and 1diarrhea 1are 1symptoms 1of
an 1illness. 1For 1some 1individuals 1of 1Mexican-American 1origin, 1however, 1these 1symptoms
1
1
are 1a 1normal 1part 1of 1living. 1The 1nurse 1recognizes 1that 1this 1difference 1is 1true, 1probably
1
because 1Mexican-Americans:
a. Have 1less 1efficient 1immune 1systems 1and 1are 1often 1ill.
b. Consider 1these 1symptoms 1part 1of 1normal 1living, 1not 1symptoms 1of 1ill 1health.
c. Come 1from 1Mexico, 1and 1coughing 1is 1normal 1and 1healthy 1there.
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d. Are usually in a lower socioeconomic group and are more likely to be sick.
ANS: B
The 1nurse 1needs 1to 1identify 1the 1meaning 1of 1health 1to 1the 1patient, 1remembering 1that 1concepts
are 1derived, 1in 1part, 1from 1the 1way 1in 1which 1members 1of 1the 1cultural 1group 1define 1health.
1
14. The 1nurse 1is 1reviewing 1theories 1of 1illness. 1The 1germ 1theory, 1which 1states 1that 1microscopic
1
organisms 1such 1as 1bacteria 1and 1viruses 1are 1responsible 1for 1specific 1disease 1conditions, 1is 1a
basic 1belief 1of 1which 1theory 1of 1illness?
1
a. Holistic
b. Biomedical
c. Naturalistic
d. Magicoreligious
ANS: 1B
Among 1the 1biomedical 1explanations 1for 1disease 1is 1the 1germ 1theory, 1which 1states 1that
microscopic 1organisms 1such 1as 1bacteria 1and 1viruses 1are 1responsible 1for 1specific 1disease
1
1
conditions. 1The 1naturalistic, 1or 1holistic, 1perspective 1holds 1that 1the 1forces 1of 1nature 1must 1be
1
kept 1in 1natural 1balance. 1The 1magicoreligious 1perspective 1holds 1that 1supernatural 1forces
1
dominate 1and 1cause 1illness 1or 1health.
15. An 1Asian-American 1woman 1is 1experiencing 1diarrhea, 1which 1is 1believed 1to 1be 1cold 1or 1yin.
The 1nurse 1expects 1that 1the 1woman 1is 1likely 1to 1try 1to 1treat 1it 1with:
1
a. Foods 1that 1are 1hot 1or 1yang.
b. Readings 1and 1Eastern 1medicine 1meditations.
c. High 1doses 1of 1medicines 1believed 1to 1be 1cold.
d. No 1treatment 1is 1tried 1because 1diarrhea 1is 1an 1expected 1part 1of 1life.
ANS: 1A
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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 1of 1Tao. 1Which 1statement 1most 1accurately 1reflects 1health 1in 1an 1Asian 1with 1this 1belief?
a. A 1person 1is 1able 1to 1work 1and 1produce.
b. A 1person 1is 1happy, 1stable, 1and 1feels 1good.
c. All 1aspects 1of 1the 1person 1are 1in 1perfect 1balance.
d. A 1person 1is 1able 1to 1care 1for 1others 1and 1function 1socially.
ANS: 1C
Many 1Asians 1believe 1in 1the 1yin/yang 1theory, 1in 1which 1health 1is 1believed 1to 1exist 1when 1all
aspects 1of 1the 1person 1are 1in 1perfect 1balance. 1The 1other 1statements 1do 1not 1describe 1this 1theory.
1
17. Illness 1is 1considered 1part 1of 1lifes 1rhythmic 1course 1and 1is 1an 1outward 1sign 1of
disharmony 1within. 1This 1statement 1most 1accurately 1reflects 1the 1views 1about 1illness 1from
1
1
which 1theory?
a. Naturalistic
b. Biomedical
c. Reductionist
d. Magicoreligious
ANS: 1A
The 1naturalistic 1perspective 1states 1that 1the 1laws 1of 1nature 1create 1imbalances, 1chaos, 1and 1disease.
1
From 1the 1perspective 1of 1the 1Chinese, 1for 1example, 1illness 1is 1not 1considered 1an 1introducing 1agent;
1
rather, 1illness 1is 1considered 1a 1part 1of 1lifes 1rhythmic 1course 1and 1an 1outward 1sign 1of 1disharmony
1
within. 1The 1other 1options 1are 1not 1correct.
18. An 1individual 1who 1takes 1the 1magicoreligious 1perspective 1of 1illness 1and 1disease 1is 1likely
to 1believe 1that 1his 1or 1her 1illness 1was 1caused 1by:
1
a. Germs 1and 1viruses.
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b. Supernatural forces.
c. Eating imbalanced foods.
d. An imbalance within his or her spiritual nature.
ANS: 1B
The 1basic 1premise 1of 1the 1magicoreligious 1perspective 1is 1that 1the 1world 1is 1seen 1as 1an 1arena 1in
1
which 1supernatural 1forces 1dominate. 1The 1fate 1of 1the 1world 1and 1those 1in 1it 1depends 1on 1the
actions 1of 1supernatural 1forces 1for 1good 1or 1evil. 1The 1other 1answers 1do 1not 1reflect 1the
1
1
magicoreligious 1perspective.
19. If 1an 1American 1Indian 1woman 1has 1come 1to 1the 1clinic 1to 1seek 1help 1with 1regulating
her 1diabetes, 1then 1the 1nurse 1can 1expect 1that 1she:
1
a. Will 1comply 1with 1the 1treatment 1prescribed.
b. Has 1obviously 1given 1up 1her 1belief 1in 1naturalistic 1causes 1of 1disease.
c. May 1also 1be 1seeking 1the 1assistance 1of 1a 1shaman 1or 1medicine 1man.
d. Will 1need 1extra 1help 1in 1dealing 1with 1her 1illness 1and 1may 1be 1experiencing 1a
1crisis 1of 1faith.
ANS: 1C
When 1self-treatment 1is 1unsuccessful, 1the 1individual 1may 1turn 1to 1the 1lay 1or 1folk 1healing
systems, 1to 1spiritual 1or 1religious 1healing, 1or 1to 1scientific 1biomedicine. 1In 1addition 1to 1seeking
1
1
help 1from 1a 1biomedical 1or 1scientific 1health 1care 1provider, 1patients 1may 1also 1seek 1help 1from
1
folk 1or 1religious 1healers.
20. An 1older 1Mexican-American 1woman 1with 1traditional 1beliefs 1has 1been 1admitted 1to 1an
inpatient 1care 1unit. 1A 1culturally 1sensitive 1nurse 1would:
1
a. Contact 1the 1hospital 1administrator 1about 1the 1best 1course 1of 1action.
b. Automatically 1get 1a 1curandero 1for 1her, 1because 1requesting 1one 1herself 1is
1not 1culturally 1appropriate.
c. Further 1assess 1the 1patients 1cultural 1beliefs 1and 1offer 1the 1patient 1assistance
1in 1contacting 1a 1curandero 1or 1priest 1if 1she 1desires.
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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 1addition 1to 1seeking 1help 1from 1the 1biomedical 1or 1scientific 1health 1care 1provider, 1patients
1
may 1also 1seek 1help 1from 1folk 1or 1religious 1healers. 1Some 1people, 1such 1as 1those 1of 1Mexican-
American 1or 1American-Indian 1origins, 1may 1believe 1that 1the 1cure 1is 1incomplete 1unless 1the
body, 1mind, 1and 1spirit 1are 1also 1healed 1(although 1the 1division 1of 1the 1person 1into 1parts 1is 1a
1
1
Western 1concept).
Chapter 1 6 1 Physical 1 Examination: 1 Getting 1 Started
MULTIPLE 1CHOICE
1. The 1nurse 1is 1performing 1a 1general 1survey. 1Which 1action 1is 1a 1component 1of 1the 1general 1survey?
a. Observing 1the 1patients 1body 1stature 1and 1nutritional 1status
b. Interpreting 1the 1subjective 1information 1the 1patient 1has 1reported
c. Measuring 1the 1patients 1temperature, 1pulse, 1respirations, 1and 1blood 1pressure
d. Observing 1specific 1body 1systems 1while 1performing 1the 1physical 1assessment
ANS: 1A
The 1general 1survey 1is 1a 1study 1of 1the 1whole 1person 1that 1includes 1observing 1the 1patients 1physical
1
appearance, 1body 1structure, 1mobility, 1and 1behavior.
2. When 1measuring 1a 1patients 1weight, 1the 1nurse 1is 1aware 1of 1which 1of 1these 1guidelines?
a. The 1patient 1is 1always 1weighed 1wearing 1only 1his 1or 1her 1undergarments.
b. The 1type 1of 1scale 1does 1not 1matter, 1as 1long 1as 1the 1weights 1are 1similar 1from 1day
1to 1day.
c. The 1patient 1may 1leave 1on 1his 1or 1her 1jacket 1and 1shoes 1as 1long 1as 1these
1are 1documented 1next 1to 1the 1weight.
d. Attempts 1should 1be 1made 1to 1weigh 1the 1patient 1at 1approximately 1the 1same 1time
1of 1day, 1if 1a 1sequence 1of 1weights 1is 1necessary.
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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 1attempt 1to 1weigh 1the 1patient 1at 1approximately 1the 1same 1time 1of 1day 1and 1with 1the 1same
1
types 1of 1clothing 1worn 1each 1time.
3. A 1patients 1weekly 1blood 1pressure 1readings 1for 12 1months 1have 1ranged 1between 1124/84 1mm
1
Hg 1and 1136/88 1mm 1Hg, 1with 1an 1average 1reading 1of 1126/86 1mm 1Hg. 1The 1nurse 1knows 1that 1this
blood 1pressure 1falls 1within 1which 1blood 1pressure 1category?
1
a. Normal 1blood 1pressure
b. Prehypertension
c. Stage 11 1hypertension
d. Stage 12 1hypertension
ANS: 1B
According 1to 1the 1Seventh 1Report 1of 1the 1Joint 1National 1Committee 1(JNC 17) 1guidelines,
1
prehypertension 1blood 1pressure 1readings 1are 1systolic 1readings 1of 1120 1to 1139 1mm 1Hg 1or
diastolic 1readings 1of 150 1to 189 1mm 1Hg.
1
4. During 1an 1examination 1of 1a 1child, 1the 1nurse 1considers 1that 1physical 1growth 1is 1the 1best 1index
1
of 1a 1childs:
a. General 1health.
b. Genetic 1makeup.
c. Nutritional 1status.
d. Activity 1and 1exercise 1patterns.
ANS: 1A
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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. 1Based 1on 1the 1interpretation 1of 1these 1findings, 1the 1nurse 1would:
a. Refer 1the 1infant 1to 1a 1physician 1for 1further 1evaluation.
b. Consider 1these 1findings 1normal 1for 1a 11-month-old 1infant.
c. Expect 1the 1chest 1circumference 1to 1be 1greater 1than 1the 1head 1circumference.
d. Ask 1the 1parent 1to 1return 1in 12 1weeks 1to 1re-evaluate 1the 1head 1and
1chest 1circumferences.
ANS: 1B
The 1newborns 1head 1measures 1approximately 132 1to 138 1cm 1and 1is 1approximately 12 1cm 1larger
than 1the 1chest 1circumference. 1Between 16 1months 1and 12 1years, 1both 1measurements 1are
1
1
approximately 1the 1same, 1and 1after 1age 12 1years, 1the 1chest 1circumference 1is 1greater 1than 1the
1
head 1circumference.
6. The 1nurse 1is 1assessing 1an 180-year-old 1male 1patient. 1Which 1assessment 1findings 1would
be 1considered 1normal?
1
a. Increase 1in 1body 1weight 1from 1his 1younger 1years
b. Additional 1deposits 1of 1fat 1on 1the 1thighs 1and 1lower 1legs
c. Presence 1of 1kyphosis 1and 1flexion 1in 1the 1knees 1and 1hips
d. Change 1in 1overall 1body 1proportion, 1including 1a 1longer 1trunk 1and
1shorter 1extremities
ANS: 1C
Changes 1that 1occur 1in 1the 1aging 1person 1include 1more 1prominent 1bony 1landmarks, 1decreased
body 1weight 1(especially 1in 1men), 1a 1decrease 1in 1subcutaneous 1fat 1from 1the 1face 1and 1periphery,
1
1
and 1additional 1fat 1deposited 1on 1the 1abdomen 1and 1hips. 1Postural 1changes 1of 1kyphosis 1and 1slight
1
flexion 1in 1the 1knees 1and 1hips 1also 1occur.
7. The 1nurse 1should 1measure 1rectal 1temperatures 1in 1which 1of 1these 1patients?
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a. School-age child
b. Older adult
c. Comatose adult
d. 1 Patient 1receiving 1oxygen 1by 1nasal 1cannula
ANS: 1C
Rectal 1temperatures 1should 1be 1taken 1when 1the 1other 1routes 1are 1impractical, 1such 1as 1for
comatose 1or 1confused 1persons, 1for 1those 1in 1shock, 1or 1for 1those 1who 1cannot 1close 1the 1mouth
1
1
because 1of 1breathing 1or 1oxygen 1tubes, 1a 1wired 1mandible, 1or 1other 1facial 1dysfunctions.
8. The 1nurse 1is 1preparing 1to 1measure 1the 1length, 1weight, 1chest, 1and 1head 1circumference 1of 1a
6- 1month-old 1infant. 1Which 1measurement 1technique 1is 1correct?
1
a. Measuring 1the 1infants 1length 1by 1using 1a 1tape 1measure
b. Weighing 1the 1infant 1by 1placing 1him 1or 1her 1on 1an 1electronic 1standing 1scale
c. Measuring 1the 1chest 1circumference 1at 1the 1nipple 1line 1with 1a 1tape 1measure
d. Measuring 1the 1head 1circumference 1by 1wrapping 1the 1tape 1measure 1over 1the
1nose 1and 1cheekbones
ANS: 1C
To 1measure 1the 1chest 1circumference, 1the 1tape 1is 1encircled 1around 1the 1chest 1at 1the 1nipple 1line.
The 1length 1should 1be 1measured 1on 1a 1horizontal 1measuring 1board. 1Weight 1should 1be 1measured
1
1
on 1a 1platform-type 1balance 1scale. 1Head 1circumference 1is 1measured 1with 1the 1tape 1around 1the
1
head, 1aligned 1at 1the 1eyebrows, 1and 1at 1the 1prominent 1frontal 1and 1occipital 1bonesthe 1widest
1
span 1is 1correct.
9. The 1nurse 1knows 1that 1one 1advantage 1of 1the 1tympanic 1membrane 1thermometer 1(TMT) 1is 1that:
a. Rapid 1measurement 1is 1useful 1for 1uncooperative 1younger 1children.
b. Using 1the 1TMT 1is 1the 1most 1accurate 1method 1for 1measuring 1body 1temperature
1in 1newborn 1infants.
c. Measuring 1temperature 1using 1the 1TMT 1is 1inexpensive.
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d. Studies strongly support the use of the TMT in children under the age 6 years.
ANS: A
The 1TMT 1is 1useful 1for 1young 1children 1who 1may 1not 1cooperate 1for 1oral 1temperatures 1and 1fear
1
rectal 1temperatures. 1However, 1the 1use 1a 1TMT 1with 1newborn 1infants 1and 1young 1children 1is
1
conflicting.
10. When 1assessing 1an 1older 1adult, 1which 1vital 1sign 1changes 1occur 1with 1aging?
a. Increase 1in 1pulse 1rate
b. Widened 1pulse 1pressure
c. Increase 1in 1body 1temperature
d. Decrease 1in 1diastolic 1blood 1pressure
ANS: 1B
With 1aging, 1the 1nurse 1keeps 1in 1mind 1that 1the 1systolic 1blood 1pressure 1increases, 1leading 1to
1
widened 1pulse 1pressure. 1With 1many 1older 1people, 1both 1the 1systolic 1and 1diastolic 1pressures
1
increase. 1The 1pulse 1rate 1and 1temperature 1do 1not 1increase.
11. The 1nurse 1is 1examining 1a 1patient 1who 1is 1complaining 1of 1feeling 1cold. 1Which 1is 1a
mechanism 1of 1heat 1loss 1in 1the 1body?
1
a. Exercise
b. Radiation
c. Metabolism
d. Food 1digestion
ANS: 1B
The 1body 1maintains 1a 1steady 1temperature 1through 1a 1thermostat 1or 1feedback 1mechanism, 1which 1is
1
regulated 1in 1the 1hypothalamus 1of 1the 1brain. 1The 1hypothalamus 1regulates 1heat 1production 1from
1
metabolism, 1exercise, 1food 1digestion, 1and 1external 1factors 1with 1heat 1loss 1through 1radiation,
1
evaporation 1of 1sweat, 1convection, 1and 1conduction.
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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 1emotional 1state.
c. Diurnal 1cycle.
d. Nocturnal 1cycle.
ANS: 1C
Normal 1temperature 1is 1influenced 1by 1the 1diurnal 1cycle, 1exercise, 1and 1age. 1The 1other 1responses
do 1not 1influence 1body 1temperature.
1
13. When 1evaluating 1the 1temperature 1of 1older 1adults, 1the 1nurse 1should 1remember 1which
aspect 1about 1an 1older 1adults 1body 1temperature?
1
a. The 1body 1temperature 1of 1the 1older 1adult 1is 1lower 1than 1that 1of 1a 1younger 1adult.
b. An 1older 1adults 1body 1temperature 1is 1approximately 1the 1same 1as 1that 1of 1a
1young 1child.
c. Body 1temperature 1depends 1on 1the 1type 1of 1thermometer 1used.
d. In 1the 1older 1adult, 1the 1body 1temperature 1varies 1widely 1because 1of 1less
1effective 1heat 1control 1mechanisms.
ANS: 1A
In 1older 1adults, 1the 1body 1temperature 1is 1usually 1lower 1than 1in 1other 1age 1groups, 1with 1a 1mean
1
temperature 1of 136.2 1C.
14. A 160-year-old 1male 1patient 1has 1been 1treated 1for 1pneumonia 1for 1the 1past 16 1weeks. 1He 1is
1
seen 1today 1in 1the 1clinic 1for 1an 1unexplained 1weight 1loss 1of 110 1pounds 1over 1the 1last 16 1weeks.
The 1nurse 1knows 1that:
1
a. Weight 1loss 1is 1probably 1the 1result 1of 1unhealthy 1eating 1habits.
b. Chronic 1diseases 1such 1as 1hypertension 1cause 1weight 1loss.
c. Unexplained 1weight 1loss 1often 1accompanies 1short-term 1illnesses.
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d. Weight loss is probably the result of a mental health dysfunction.
ANS: C
An 1unexplained 1weight 1loss 1may 1be 1a 1sign 1of 1a 1short-term 1illness 1or 1a 1chronic 1illness 1such 1as
1
endocrine 1disease, 1malignancy, 1depression, 1anorexia 1nervosa, 1or 1bulimia.
15. When 1assessing 1a 175-year-old 1patient 1who 1has 1asthma, 1the 1nurse 1notes 1that 1he 1assumes 1a
1
tripod 1position, 1leaning 1forward 1with 1arms 1braced 1on 1the 1chair. 1On 1the 1basis 1of 1this
observation, 1the 1nurse 1should:
1
a. Assume 1that 1the 1patient 1is 1eager 1and 1interested 1in 1participating 1in 1the 1interview.
b. Evaluate 1the 1patient 1for 1abdominal 1pain, 1which 1may 1be 1exacerbated 1in 1the
1sitting 1position.
c. Assume 1that 1the 1patient 1is 1having 1difficulty 1breathing 1and 1assist 1him 1to 1a
1supine 1position.
d. Recognize 1that 1a 1tripod 1position 1is 1often 1used 1when 1a 1patient 1is 1having
1respiratory 1difficulties.
ANS: 1D
Assuming 1a 1tripod 1positionleaning 1forward 1with 1arms 1braced 1on 1chair 1armsoccurs 1with 1chronic
1
pulmonary 1disease. 1The 1other 1actions 1or 1assumptions 1are 1not 1correct.
16. Which 1of 1these 1actions 1illustrates 1the 1correct 1technique 1the 1nurse 1should 1use 1when
assessing 1oral 1temperature 1with 1a 1mercury 1thermometer?
1
a. Wait 130 1minutes 1if 1the 1patient 1has 1ingested 1hot 1or 1iced 1liquids.
b. Leave 1the 1thermometer 1in 1place 13 1to 14 1minutes 1if 1the 1patient 1is 1afebrile.
c. Place 1the 1thermometer 1in 1front 1of 1the 1tongue, 1and 1ask 1the 1patient 1to 1close 1his
1or 1her 1lips.
d. Shake 1the 1mercury-in-glass 1thermometer 1down 1to 1below 136.6 1C 1before 1taking
1the 1temperature.
ANS: 1B
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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 1nurse 1is 1taking 1temperatures 1in 1a 1clinic 1with 1a 1TMT. 1Which 1statement 1is 1true
regarding 1use 1of 1the 1TMT?
1
a. A 1tympanic 1temperature 1is 1more 1time 1consuming 1than 1a 1rectal 1temperature.
b. The 1tympanic 1method 1is 1more 1invasive 1and 1uncomfortable 1than 1the 1oral 1method.
c. The 1risk 1of 1cross-contamination 1is 1reduced, 1compared 1with 1the 1rectal 1route.
d. The 1tympanic 1membrane 1most 1accurately 1reflects 1the 1temperature 1in
1the 1ophthalmic 1artery.
ANS: 1C
The 1TMT 1is 1a 1noninvasive, 1nontraumatic 1device 1that 1is 1extremely 1quick 1and 1efficient. 1The
chance 1of 1cross-contamination 1with 1the 1TMT 1is 1minimal 1because 1the 1ear 1canal 1is 1lined 1with
1
1
skin, 1not 1mucous 1membranes.
18. To 1assess 1a 1rectal 1temperature 1accurately 1in 1an 1adult, 1the 1nurse 1would:
a. Use 1a 1lubricated 1blunt 1tip 1thermometer.
b. Insert 1the 1thermometer 12 1to 13 1inches 1into 1the 1rectum.
c. Leave 1the 1thermometer 1in 1place 1up 1to 18 1minutes 1if 1the 1patient 1is 1febrile.
d. Wait 12 1to 13 1minutes 1if 1the 1patient 1has 1recently 1smoked 1a 1cigarette.
ANS: 1A
A 1lubricated 1rectal 1thermometer 1(with 1a 1short, 1blunt 1tip) 1is 1inserted 1only 12 1to 13 1cm 1(1 1inch)
into 1the 1adult 1rectum 1and 1left 1in 1place 1for 12 1minutes. 1Cigarette 1smoking 1does 1not 1alter 1rectal
1
1
temperatures.
19. Which 1technique 1is 1correct 1when 1the 1nurse 1is 1assessing 1the 1radial 1pulse 1of 1a 1patient?
The 1pulse 1is 1counted 1for:
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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. 1 10 1seconds 1and 1then 1multiplied 1by 16, 1if 1the 1patient 1has 1no 1history 1of 1cardiac
1abnormalities.
ANS: 1A
Recent 1research 1suggests 1that 1the 130-second 1interval 1multiplied 1by 12 1is 1the 1most 1accurate
and 1efficient 1technique 1when 1heart 1rates 1are 1normal 1or 1rapid 1and 1when 1rhythms 1are
1
regular. 1If 1the 1rhythm 1is 1irregular, 1then 1the 1pulse 1is 1counted 1for 11 1full 1minute.
1
20. When 1assessing 1a 1patients 1pulse, 1the 1nurse 1should 1also 1notice 1which 1of 1these 1characteristics?
a. Force
b. Pallor
c. Capillary 1refill 1time
d. Timing 1in 1the 1cardiac 1cycle
ANS: 1A
The 1pulse 1is 1assessed 1for 1rate, 1rhythm, 1and 1force.
Chapter 17 1Beginning 1the 1Physical 1Examination: 1General 1 Survey, 1 Vital 1 Signs, 1 and
1Pain
Multiple 1Choice
1. A 115-year-old 1high 1school 1sophomore 1and 1her 1mother 1come 1to 1your 1clinic 1because 1the
1mother 1is 1concerned 1about 1her 1daughter's 1weight. 1You 1measure 1her 1daughter's 1height 1and
2
1weight 1and 1obtain 1a 1BMI 1of 119.5 1kg/m . 1Based 1on 1this 1information, 1which 1of 1the 1following 1is
1appropriate?
A) Refer 1the 1patient 1to 1a 1nutritionist 1and 1a 1psychologist 1because 1the 1patient 1is 1anorexic.
B) Reassure 1the 1mother 1that 1this 1is 1a 1normal 1body 1weight.
C) Give 1the 1patient 1information 1about 1exercise 1because 1the 1patient 1is 1obese.
D) Give 1the 1patient 1information 1concerning 1reduction 1of 1fat 1and 1cholesterol 1in 1her 1diet
1because 1she 1is 1obese.
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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/m2.
You may be able to give the patient and her mother the lower limit of normal in pounds for her
daughter's 1height, 1or 1instruct 1her 1in 1how 1to 1use 1a 1BMI 1table.
2. A 125-year-old 1radio 1announcer 1comes 1to 1the 1clinic 1for 1an 1annual 1examination. 1His 1BMI 1is
26.0 1kg/m2. 1He 1is 1concerned 1about 1his 1weight. 1Based 1on 1this 1information, 1what 1is 1appropriate
1counsel 1for 1the 1patient 1during 1the 1visit?
A) Refer 1the 1patient 1to 1a 1nutritionist 1because 1he 1is 1anorexic.
B) Reassure 1the 1patient 1that 1he 1has 1a 1normal 1body 1weight.
C) Give 1the 1patient 1information 1about 1reduction 1of 1fat, 1cholesterol, 1and 1calories 1because 1he
1is 1overweight.
D) Give 1the 1patient 1information 1about 1reduction 1of 1fat 1and 1cholesterol 1because 1he 1is 1obese.
Ans: 1C
Feedback: 1The 1patient 1has 1a 1BMI 1in 1the 1overweight 1range, 1which 1is 125.0 1to 129.9 1kg/m2. 1It 1is
1prudent 1to 1give 1him 1information 1about 1reducing 1calories, 1fat, 1and 1cholesterol 1in 1his 1diet 1to
1help 1prevent 1further 1weight 1gain.
3. A 130-year-old 1sales 1clerk 1comes 1to 1your 1office 1wanting 1to 1lose 1weight; 1her 1BMI 1is 130.0
2
1kg/m . 1What 1is 1the 1most 1appropriate 1amount 1for 1a 1weekly 1weight 1reduction 1goal?
A) .5 1to 11 1pound 1per 1week
B) 1 1to 12.5 1pounds 1per 1week
C) 2.5 1to 13.5 1pounds 1per 1week
D) 3.5 1to 14.5 1pounds 1per 1week
Ans: 1A
Feedback: 1 Based 1on 1the 1NIH 1Obesity 1Guidelines, 1this 1is 1the 1weekly 1weight 1loss 1goal 1to 1strive
1for 1to 1maintain 1long-term 1control 1of 1weight. 1More 1rapid 1weight 1loss 1than 1this 1does 1not 1result
1in 1a 1better 1outcome 1at 1one 1year.
4. A 167-year-old 1retired 1janitor 1comes 1to 1the 1clinic 1with 1his 1wife. 1She 1brought 1him 1in 1because
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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 1lung 1cancer?
A) Have 1you 1tried 1to 1force 1yourself 1to 1vomit 1after 1eating 1a 1meal?
B) Do 1you 1have 1heartburn/indigestion 1and 1diarrhea?
C) Do 1you 1have 1enough 1food 1to 1eat?
D) Have 1you 1tried 1to 1lose 1weight?
Ans: 1D
Feedback: 1This 1is 1important: 1If 1the 1patient 1hasn't 1tried 1to 1lose 1weight, 1then 1this 1weight 1loss 1is
1inadvertent 1and 1poses 1concern 1for 1a 1neoplastic 1process, 1especially 1given 1his 1smoking 1history.
5. Common 1or 1concerning 1symptoms 1to 1inquire 1about 1in 1the 1General 1Survey 1and 1vital
1signs 1include 1all 1of 1the 1following 1except:
A) Changes 1in 1weight
B) Fatigue 1and 1weakness
C) Cough
D) Fever 1and 1chills
Ans: 1C
Feedback: 1 This 1symptom 1is 1more 1appropriate 1to 1the 1respiratory 1review 1of 1systems.
6. You 1are 1beginning 1the 1examination 1of 1a 1patient. 1All 1of 1the 1following 1areas 1are 1important
1to 1observe 1as 1part 1of 1the 1General 1Survey 1except:
A) Level 1of 1consciousness
B) Signs 1of 1distress
C) Dress, 1grooming, 1and 1personal 1hygiene
D) Blood 1pressure
Ans: 1D
Feedback: 1 Blood 1pressure 1is 1a 1vital 1sign, 1not 1part 1of 1the 1General 1Survey.
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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 1pressure 1cuff 1is 1tightly 1fitted.
B) Patient 1is 1seated 1quietly 1for 110 1minutes 1prior 1to 1measurement.
C) Blood 1pressure 1is 1measured 1on 1a 1bare 1arm.
D) Patient's 1arm 1is 1resting, 1supported 1by 1your 1arm 1at 1her 1mid-chest 1level 1as 1you 1stand 1to
1measure 1the 1blood 1pressure.
Ans: 1A
Feedback: 1A 1blood 1pressure 1cuff 1that 1is 1too 1tightly 1fitted 1can 1result 1in 1a 1false 1high 1reading.
1The 1other 1answers 1are 1important 1to 1observe 1to 1obtain 1an 1accurate 1blood 1pressure 1reading.
1JNC-7 1also 1mentions 1the 1importance 1of 1having 1the 1back 1supported 1when 1obtaining 1blood
1pressure 1in 1the 1sitting 1position.
8. A 149-year-old 1truck 1driver 1comes 1to 1the 1emergency 1room 1for 1shortness 1of 1breath 1and
1swelling 1in 1his 1ankles. 1He 1is 1diagnosed 1with 1congestive 1heart 1failure 1and 1admitted 1to 1the
1hospital. 1You 1are 1the 1student 1assigned 1to 1do 1the 1patient's 1complete 1history 1and 1physical
1examination. 1When 1you 1palpate 1the 1pulse, 1what 1do 1you 1expect 1to 1feel?
A) Large 1amplitude, 1forceful
B) Small 1amplitude, 1weak
C) Normal
D) Bigeminal
Ans: 1B
Feedback: 1Congestive 1heart 1failure 1is 1characterized 1by 1decreased 1stroke 1volume 1or 1increased
1peripheral 1vascular 1resistance, 1which 1would 1result 1in 1a 1small-amplitude, 1weak 1pulse. 1Subtle
1differences 1in 1amplitude 1are 1usually 1best 1detected 1in 1large 1arteries 1close 1to 1the 1heart, 1like 1the
1carotid 1pulse. 1 You 1may 1not 1be 1able 1to 1notice 1these 1in 1other 1locations.
9. An 118-year-old 1college 1freshman 1presents 1to 1the 1clinic 1for 1evaluation 1of 1gastroenteritis. 1You
1measure 1the 1patient's 1temperature 1and 1it 1is 1104 1degrees 1Fahrenheit. 1What 1type 1of 1pulse 1would
1you 1expect 1to 1feel 1during 1his 1initial 1examination?
A) Large 1amplitude, 1forceful
B) Small 1amplitude, 1weak
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C) Normal
D) Bigeminal
Ans: A
Feedback: 1Fever 1results 1in 1an 1increased 1stroke 1volume, 1which 1results 1in 1a 1large-amplitude,
1forceful 1pulse. 1 Later 1in 1the 1course 1of 1the 1illness, 1if 1dehydration 1and 1shock 1result, 1you 1may
1expect 1small 1amplitude 1and 1weak 1pulses.
10. A 125-year-old 1type 11 1diabetic 1clerk 1presents 1to 1the 1emergency 1room 1with 1shortness 1of
1breath 1and 1states 1that 1his 1blood 1sugar 1was 1605 1at 1home. 1You 1diagnose 1the 1patient 1with
1diabetic 1ketoacidosis. 1What 1is 1the 1expected 1pattern 1of 1breathing?
A) Normal
B) Rapid 1and 1shallow
C) Rapid 1and 1deep
D) Slow
Ans: 1C
Feedback: 1This 1is 1the 1expected 1rate 1and 1depth 1in 1diabetic 1ketoacidosis. 1The 1body 1is 1trying 1to
1rid 1itself 1of 1carbon 1dioxide 1to 1compensate 1for 1the 1acidosis. 1This 1is 1known 1as 1Kussmaul's
1breathing 1and 1is 1seen 1in 1other 1causes 1of 1acidosis 1as 1well.
11. Mrs. 1Lenzo 1weighs 1herself 1every 1day 1with 1a 1very 1accurate 1balance-type 1scale. 1She 1has
1noticed 1that 1over 1the 1past 12 1days 1she 1has 1gained 14 1pounds. 1 How 1would 1you 1best 1explain
1this?
A) Attribute 1this 1to 1some 1overeating 1at 1the 1holidays.
B) Attribute 1this 1to 1wearing 1different 1clothing.
C) Attribute 1this 1to 1body 1fluid.
D) Attribute 1this 1to 1instrument 1inaccuracy.
Ans: 1C
Feedback: 1This 1amount 1of 1weight 1over 1a 1short 1period 1should 1make 1one 1think 1of 1body 1fluid
1changes. 1You 1may 1consider 1a 1kidney 1problem 1or 1heart 1failure 1in 1your 1differential. 1The 1other
1reasons 1should 1be 1considered 1as 1well, 1but 1this 1amount 1of 1weight 1gain 1over 1a 1short 1period
1usually 1indicates 1causes 1other 1than 1excessive 1caloric 1intake. 1A 1rule 1of 1thumb 1for 1dieters 1is 1that
1an 1energy 1excess 1of 13500 1calories 1will 1cause 1a 11-pound 1weight 1gain, 1if 1the 1increase 1is 1to 1be
1attributed 1to 1food 1intake.
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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 1you 1get 1down 1to 1your 1goal 1weight, 1you 1will 1feel 1so 1much 1better.‖
B) ―Some 1people 1seem 1to 1be 1able 1to 1lose 1weight 1and 1others 1just 1can't, 1no 1matter 1how 1hard
1they 1try.‖
C) ―We 1are 1coming 1up 1with 1new 1medicines 1and 1methods 1to 1treat 1your 1conditions 1every 1day.‖
D) ―Even 1a 1weight 1loss 1of 110% 1can 1make 1a 1noticeable 1improvement 1in 1the 1problems 1you
1mention.‖
Ans: 1D
Feedback: 1Many 1patients 1trying 1to 1change 1a 1habit 1are 1overwhelmed 1by 1how 1far 1they 1are 1from
1their 1goal. 1As 1the 1proverb 1says: 1―A 1journey 1of 1a 1thousand 1miles 1begins 1with 1one 1step.‖ 1Many
1patients 1find 1it 1empowering 1to 1know 1that 1they 1can 1achieve 1a 1small 1goal, 1such 1as 1a 1loss 1of 11
1pound 1per 1week. 1They 1must 1be 1reminded 1that 1this 1process 1will 1take 1time 1and 1that 1slow 1weight
1loss 1is 1more 1successful 1long-term. 1Research 1has 1shown 1that 1significant 1benefits 1often 1come
1with 1even 1a 110% 1weight 1loss.
13. Jenny 1is 1one 1of 1your 1favorite 1patients 1who 1usually 1shares 1a 1joke 1with 1you 1and 1is
1nattily 1dressed. 1Today 1she 1is 1dressed 1in 1old 1jeans, 1lacks 1makeup, 1and 1avoids 1eye 1contact.
1To 1what 1do 1you 1attribute 1these 1changes?
A) She 1is 1lacking 1sleep.
B) She 1is 1fatigued 1from 1work.
C) She 1is 1running 1into 1financial 1difficulty.
D) She 1is 1depressed.
Ans: 1D
Feedback: 1It 1is 1important 1to 1use 1all 1of 1your 1skills 1and 1memory 1of 1an 1individual 1patient 1to
1guide 1your 1thought 1process. 1She 1is 1not 1described 1as 1sleepy. 1Work 1fatigue 1would 1most 1likely
1not 1cause 1avoidance 1of 1eye 1contact. 1 Financial 1difficulties 1would 1not 1necessarily 1deplete 1a
1nice 1wardrobe. 1It 1is 1most 1likely 1that 1she 1is 1depressed 1or 1in 1another 1type 1of 1difficulty.
14. You 1are 1seeing 1an 1older 1patient 1who 1has 1not 1had 1medical 1care 1for 1many 1years. 1Her 1vital
1signs 1taken 1by 1your 1office 1staff 1are: 1T 137.2, 1HR 178, 1BP 1118/92, 1and 1RR 114, 1and 1she 1denies
1pain. 1You 1notice 1that 1she 1has 1some 1hypertensive 1changes 1in 1her 1retinas 1and 1you 1find 1mild
1proteinuria
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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) 1 It 1is 1caused 1by 1resolution 1of 1the 1process 1which 1caused 1her 1retinopathy 1and 1kidney 1problems.
Ans: 1A
Feedback: 1The 1blood 1pressure 1is 1unusual 1in 1this 1case 1in 1that 1the 1systolic 1pressure 1is 1normal
1while 1the 1diastolic 1pressure 1is 1elevated. 1Especially 1with 1the 1retinal 1and 1urinary 1findings, 1you
1should 1consider 1that 1the 1BP 1may 1be 1much 1higher 1and 1that 1an 1auscultatory 1gap 1was 1missed.
1This 1can 1be 1avoided 1by 1checking 1for 1obliteration 1of 1the 1radial 1pulse 1while 1the 1cuff 1is 1inflated.
1Although 1a 1large 1cuff 1can 1cause 1a 1slightly 1lower 1BP 1on 1a 1patient 1with 1a 1small 1arm, 1this 1does
1not 1account 1for 1the 1elevated 1DBP. 1Emotional 1upset 1usually 1causes 1elevation 1of 1the 1BP.
1 Although 1a 1process 1which 1caused 1the 1retinopathy 1and 1kidney 1problems 1may 1have 1resolved,
1leaving 1these 1findings, 1it 1is 1a 1dangerous 1assumption 1that 1this 1is 1the 1sole 1cause 1of 1the 1problems
1seen 1in 1this 1patient.
15. Despite 1having 1high 1BP 1readings 1in 1the 1office, 1Mr. 1Kelly 1tells 1you 1that 1his 1readings 1at
1home 1are 1much 1lower. 1He 1checks 1them 1twice 1a 1day 1at 1the 1same 1time 1of 1day 1and 1has 1kept 1a
1log. 1How 1do 1you 1respond?
A) You 1diagnose 1―white 1coat 1hypertension.‖
B) You 1assume 1he 1is 1quite 1nervous 1when 1he 1comes 1to 1your 1office.
C) You 1question 1the 1accuracy 1of 1his 1measurements.
D) You 1question 1the 1accuracy 1of 1your 1measurements.
Ans: 1C
Feedback: 1 It 1is 1not 1uncommon 1to 1see 1differences 1in 1a 1patient's 1home 1measurements 1and 1your
1own 1in 1the 1office. 1 Presuming 1that 1this 1is 1―white 1coat 1hypertension‖ 1can 1be 1dangerous
1because 1this 1condition 1is 1not 1usually 1treated. 1This 1allows 1for 1the 1effects 1of 1a 1missed 1diagnosis
1of 1hypertension 1to 1go 1unchecked. 1It 1is 1also 1very 1difficult 1to 1judge 1if 1a 1patient 1is 1outwardly
1nervous. 1You 1should 1always 1consider 1that 1your 1measurements 1are 1not 1accurate 1as 1well, 1but
1the 1fact 1that 1you 1and 1your 1staff 1are 1well-trained 1and 1perform 1this 1procedure 1on 1hundreds 1of
1patients 1a 1week 1makes 1this 1less 1likely. 1Ideally, 1you 1would 1ask 1the 1patient 1to 1bring 1in 1his 1BP
1equipment 1and 1take 1a 1simultaneous 1reading 1with 1you 1to 1make 1sure 1that 1he 1is 1getting 1an
1accurate 1reading.
Chapter 18 1Nutrition 1and 1Hydration
1
MULTIPLE 1CHOICE
1. The 1nurse 1recognizes 1which 1of 1these 1persons 1is 1at 1greatest 1risk 1for 1undernutrition?
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a. 5-month-old infant
b. 50-year-old woman
c. 20-year-old college student
d. 1 30-year-old 1hospital 1administrator
ANS: 1A
Vulnerable 1groups 1for 1undernutrition 1are 1infants, 1children, 1pregnant 1women, 1recent
immigrants, 1persons 1with 1low 1incomes, 1hospitalized 1people, 1and 1aging 1adults.
1
2. When 1assessing 1a 1patients 1nutritional 1status, 1the 1nurse 1recalls 1that 1the 1best 1definition 1of
optimal 1nutritional 1status 1is 1sufficient 1nutrients 1that:
1
a. Are 1in 1excess 1of 1daily 1body 1requirements.
b. Provide 1for 1the 1minimum 1body 1needs.
c. Provide 1for 1daily 1body 1requirements 1but 1do 1not 1support 1increased
1metabolic 1demands.
d. Provide 1for 1daily 1body 1requirements 1and 1support 1increased 1metabolic 1demands.
ANS: 1D
Optimal 1nutritional 1status 1is 1achieved 1when 1sufficient 1nutrients 1are 1consumed 1to 1support 1dayto- 1day 1body 1needs 1and 1any 1increased 1metabolic 1demands 1resulting 1from 1growth, 1pregnancy,
1
or 1illness.
3. The 1nurse 1is 1providing 1nutrition 1information 1to 1the 1mother 1of 1a 11-year-old 1child. 1Which
of 1these 1statements 1represents 1accurate 1information 1for 1this 1age 1group?
1
a. Maintaining 1adequate 1fat 1and 1caloric 1intake 1is 1important 1for 1a 1child 1in 1this
1age 1group.
b. The 1recommended 1dietary 1allowances 1for 1an 1infant 1are 1the 1same 1as 1for
1an 1adolescent.
c. The 1babys 1growth 1is 1minimal 1at 1this 1age; 1therefore, 1caloric 1requirements
1are 1decreased.
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d. The baby should be placed on skim milk to decrease the risk of coronary artery
disease when he or she grows older.
ANS: A
Because 1of 1rapid 1growth, 1especially 1of 1the 1brain, 1both 1infants 1and 1children 1younger 1than 12
1
years 1of 1age 1should 1not 1drink 1skim 1or 1low-fat 1milk 1or 1be 1placed 1on 1low-fat 1diets. 1Fats
1
(calories 1and 1essential 1fatty 1acids) 1are 1required 1for 1proper 1growth 1and 1central 1nervous 1system
1
development.
4. A 1pregnant 1woman 1is 1interested 1in 1breastfeeding 1her 1baby 1and 1asks 1several 1questions 1about
the 1topic. 1Which 1information 1is 1appropriate 1for 1the 1nurse 1to 1share 1with 1her?
1
a. Breastfeeding 1is 1best 1when 1also 1supplemented 1with 1bottle 1feedings.
b. Babies 1who 1are 1breastfed 1often 1require 1supplemental 1vitamins.
c. Breastfeeding 1is 1recommended 1for 1infants 1for 1the 1first 12 1years 1of 1life.
d. Breast 1milk 1provides 1the 1nutrients 1necessary 1for 1growth, 1as 1well 1as
1natural 1immunity.
ANS: 1D
Breastfeeding 1is 1recommended 1for 1full-term 1infants 1for 1the 1first 1year 1of 1life 1because 1breast
milk 1is 1ideally 1formulated 1to 1promote 1normal 1infant 1growth 1and 1development, 1as 1well 1as
1
1
natural 1immunity. 1The 1other 1statements 1are 1not 1correct.
5. A 1mother 1and 1her 113-year-old 1daughter 1express 1their 1concern 1related 1to 1the 1daughters
recent 1weight 1gain 1and 1her 1increase 1in 1appetite. 1Which 1of 1these 1statements 1represents
1
information 1the 1nurse 1should 1discuss 1with 1them?
1
a. Dieting 1and 1exercising 1are 1necessary 1at 1this 1age.
b. Snacks 1should 1be 1high 1in 1protein, 1iron, 1and 1calcium.
c. Teenagers 1who 1have 1a 1weight 1problem 1should 1not 1be 1allowed 1to 1snack.
d. A 1low-calorie 1diet 1is 1important 1to 1prevent 1the 1accumulation 1of 1fat.
ANS: 1B
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After a period of slow growth in late childhood, adolescence is characterized by rapid physical
growth and endocrine and hormonal changes. Caloric and protein requirements increase to meet
this demand. Because of bone growth and increasing muscle mass (and, in girls, the onset of
menarche), 1calcium 1and 1iron 1requirements 1also 1increase.
6. The 1nurse 1is 1assessing 1a 130-year-old 1unemployed 1immigrant 1from 1an 1underdeveloped
1
country 1who 1has 1been 1in 1the 1United 1States 1for 11 1month. 1Which 1of 1these 1problems 1related 1to 1his
nutritional 1status 1might 1the 1nurse 1expect 1to 1find?
1
a. Obesity
b. Hypotension
c. Osteomalacia 1(softening 1of 1the 1bones)
d. Coronary 1artery 1disease
ANS: 1C
General 1undernutrition, 1hypertension, 1diarrhea, 1lactose 1intolerance, 1osteomalacia, 1scurvy,
1
and 1dental 1caries 1are 1among 1the 1more 1common 1nutrition-related 1problems 1of 1new
immigrants 1from 1developing 1countries.
1
7. For 1the 1first 1time, 1the 1nurse 1is 1seeing 1a 1patient 1who 1has 1no 1history 1of 1nutritionrelated 1problems. 1The 1initial 1nutritional 1screening 1should 1include 1which 1activity?
a. Calorie 1count 1of 1nutrients
b. Anthropometric 1measures
c. Complete 1physical 1examination
d. Measurement 1of 1weight 1and 1weight 1history
ANS: 1D
Parameters 1used 1for 1nutrition 1screening 1typically 1include 1weight 1and 1weight 1history, 1conditions
1
associated 1with 1increased 1nutritional 1risk, 1diet 1information, 1and 1routine 1laboratory 1data. 1The 1other
1
responses 1reflect 1a 1more 1in-depth 1assessment 1rather 1than 1a 1screening.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
8. A patient is asked to indicate on a form how many times he eats a specific food. This method
describes which of these tools for obtaining dietary information?
a. Food diary
b. Calorie 1count
c. 24-hour 1recall
d. Food-frequency 1questionnaire
ANS: 1D
With 1this 1tool, 1information 1is 1collected 1on 1how 1many 1times 1per 1day, 1week, 1or 1month 1the
1
individual 1eats 1particular 1foods, 1which 1provides 1an 1estimate 1of 1usual 1intake.
9. The 1nurse 1is 1providing 1care 1for 1a 168-year-old 1woman 1who 1is 1complaining 1of
constipation. 1What 1concern 1exists 1regarding 1her 1nutritional 1status?
1
a. Absorption 1of 1nutrients 1may 1be 1impaired.
b. Constipation 1may 1represent 1a 1food 1allergy.
c. The 1patient 1may 1need 1emergency 1surgery 1to 1correct 1the 1problem.
d. Gastrointestinal 1problems 1will 1increase 1her 1caloric 1demand.
ANS: 1A
Gastrointestinal 1symptoms 1such 1as 1vomiting, 1diarrhea, 1or 1constipation 1may 1interfere 1with 1nutrient
1
intake 1or 1absorption. 1The 1other 1responses 1are 1not 1correct.
10. During 1a 1nutritional 1assessment, 1why 1is 1it 1important 1for 1the 1nurse 1to 1ask 1a 1patient
what 1medications 1he 1or 1she 1is 1taking?
1
a. Certain 1drugs 1can 1affect 1the 1metabolism 1of 1nutrients.
b. The 1nurse 1needs 1to 1assess 1the 1patient 1for 1allergic 1reactions.
c. Medications 1need 1to 1be 1documented 1in 1the 1record 1for 1the 1physicians 1review.
d. Medications 1can 1affect 1ones 1memory 1and 1ability 1to 1identify 1food 1eaten 1in 1the
1last 124 1hours.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
ANS: A
Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs,
steroids, and oral contraceptives are drugs that can interact with nutrients, impairing their
digestion, 1absorption, 1metabolism, 1or 1use. 1The 1other 1responses 1are 1not 1correct.
11. A 1patient 1tells 1the 1nurse 1that 1his 1food 1simply 1does 1not 1have 1any 1taste 1anymore. 1The
nurses 1best 1response 1would 1be:
1
a. That 1must 1be 1really 1frustrating.
b. When 1did 1you 1first 1notice 1this 1change?
c. My 1food 1doesnt 1always 1have 1a 1lot 1of 1taste 1either.
d. Sometimes 1that 1happens, 1but 1your 1taste 1will 1come 1back.
ANS: 1B
With 1changes 1in 1appetite, 1taste, 1smell, 1or 1chewing 1or 1swallowing, 1the 1examiner 1should 1ask
about 1the 1type 1of 1change 1and 1when 1the 1change 1occurred. 1These 1problems 1interfere 1with
1
1
adequate 1nutrient 1intake. 1The 1other 1responses 1are 1not 1correct.
12. The 1nurse 1is 1performing 1a 1nutritional 1assessment 1on 1a 115-year-old 1girl 1who 1tells 1the 1nurse
that 1she 1is 1so 1fat. 1Assessment 1reveals 1that 1she 1is 15 1feet 14 1inches 1and 1weighs 1110 1pounds. 1The
1
1
nurses 1appropriate 1response 1would 1be:
a. How 1much 1do 1you 1think 1you 1should 1weigh?
b. Dont 1worry 1about 1it; 1youre 1not 1that 1overweight.
c. The 1best 1thing 1for 1you 1would 1be 1to 1go 1on 1a 1diet.
d. I 1used 1to 1always 1think 1I 1was 1fat 1when 1I 1was 1your 1age.
ANS: 1A
Adolescents 1increased 1body 1awareness 1and 1self-consciousness 1may 1cause 1eating 1disorders 1such
1
as 1anorexia 1nervosa 1or 1bulimia, 1conditions 1in 1which 1the 1real 1or 1perceived 1body 1image 1does
1
not
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
favorably compare with an ideal image. The nurse should not belittle the adolescents feelings,
provide unsolicited advice, or agree with her.
13. The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of
these 1foods 1are 1recommended?
a. Foods 1that 1the 1child 1will 1eat, 1no 1matter 1what 1they 1are
b. Foods 1easy 1to 1hold 1such 1as 1hot 1dogs, 1nuts, 1and 1grapes
c. Any 1foods, 1as 1long 1as 1the 1rest 1of 1the 1family 1is 1also 1eating 1them
d. Finger 1foods 1and 1nutritious 1snacks 1that 1cannot 1cause 1choking
ANS: 1D
Small 1portions, 1finger 1foods, 1simple 1meals, 1and 1nutritious 1snacks 1help 1improve 1the 1dietary
intake 1of 1young 1children. 1Foods 1likely 1to 1be 1aspirated 1should 1be 1avoided 1(e.g., 1hot 1dogs, 1nuts,
1
1
grapes, 1round 1candies, 1popcorn).
14. The 1nurse 1is 1reviewing 1the 1nutritional 1assessment 1of 1an 182-year-old 1patient. 1Which 1of
these 1factors 1will 1most 1likely 1affect 1the 1nutritional 1status 1of 1an 1older 1adult?
1
a. Increase 1in 1taste 1and 1smell
b. Living 1alone 1on 1a 1fixed 1income
c. Change 1in 1cardiovascular 1status
d. Increase 1in 1gastrointestinal 1motility 1and 1absorption
ANS: 1B
Socioeconomic 1conditions 1frequently 1affect 1the 1nutritional 1status 1of 1the 1aging 1adult; 1these
factors 1should 1be 1closely 1evaluated. 1Physical 1limitations, 1income, 1and 1social 1isolation 1are
1
1
frequent 1problems 1that 1interfere 1with 1the 1acquisition 1of 1a 1balanced 1diet. 1A 1decrease 1in 1taste
1
and 1smell 1and 1decreased 1gastrointestinal 1motility 1and 1absorption 1occur 1with 1aging.
1
Cardiovascular 1status 1is 1not 1a 1factor 1that 1affects 1an 1older 1adults 1nutritional 1status.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
15. When considering a nutritional assessment, the nurse is aware that the most common
anthropometric measurements include:
a. Height and weight.
b. Leg 1circumference.
c. Skinfold 1thickness 1of 1the 1biceps.
d. Hip 1and 1waist 1measurements.
ANS: 1A
The 1most 1commonly 1used 1anthropometric 1measures 1are 1height, 1weight, 1triceps 1skinfold
1
thickness, 1elbow 1breadth, 1and 1arm 1and 1head 1circumferences.
16. If 1a 129-year-old 1woman 1weighs 1156 1pounds, 1and 1the 1nurse 1determines 1her 1ideal 1body
weight 1to 1be 1120 1pounds, 1then 1how 1would 1the 1nurse 1classify 1the 1womans 1weight?
1
a. Obese
b. Mildly 1overweight
c. Suffering 1from 1malnutrition
d. Within 1appropriate 1range 1of 1ideal 1weight
ANS: 1A
Obesity, 1as 1a 1result 1of 1caloric 1excess, 1refers 1to 1weight 1more 1than 120% 1above 1ideal 1body
weight. 1For 1this 1patient, 120% 1of 1her 1ideal 1body 1weight 1would 1be 124 1pounds, 1and 1greater 1than
1
20% 1of 1her 1body 1weight 1would 1be 1over 1144 1pounds. 1Therefore, 1having 1a 1weight 1of 1156
1
1
pounds 1would 1be 1considered 1obese.
17. How 1should 1the 1nurse 1perform 1a 1triceps 1skinfold 1assessment?
a. After 1pinching 1the 1skin 1and 1fat, 1the 1calipers 1are 1vertically 1applied 1to 1the 1fat 1fold.
b. The 1skin 1and 1fat 1on 1the 1front 1of 1the 1patients 1arm 1are 1gently 1pinched, 1and 1then
1the 1calipers 1are 1applied.
c. After 1applying 1the 1calipers, 1the 1nurse 1waits 13 1seconds 1before 1taking 1a
1reading. 1After 1repeating 1the 1procedure 1three 1times, 1an 1average 1is 1recorded.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
d. The patient is instructed to stand with his or her back to the examiner and arms
folded across the chest. The skin on the forearm is pinched.
ANS: C
While 1holding 1the 1skinfold, 1the 1lever 1of 1the 1calipers 1is 1released. 1The 1nurse 1waits 13 1seconds
1
and 1then 1takes 1a 1reading. 1This 1procedure 1should 1be 1repeated 1three 1times, 1and 1an 1average 1of
the 1three 1skinfold 1measurements 1is 1then 1recorded.
1
18. In 1teaching 1a 1patient 1how 1to 1determine 1total 1body 1fat 1at 1home, 1the 1nurse 1includes
instructions 1to 1obtain 1measurements 1of:
1
a. Height 1and 1weight.
b. Frame 1size 1and 1weight.
c. Waist 1and 1hip 1circumferences.
d. Mid-upper 1arm 1circumference 1and 1arm 1span.
ANS: 1A
Body 1mass 1index, 1calculated 1by 1using 1height 1and 1weight 1measurements, 1is 1a 1practical 1marker
of 1optimal 1weight 1for 1height 1and 1an 1indicator 1of 1obesity. 1The 1other 1options 1are 1not 1correct.
1
19. The 1nurse 1is 1evaluating 1patients 1for 1obesity-related 1diseases 1by 1calculating 1the 1waist-tohip 1ratios. 1Which 1one 1of 1these 1patients 1would 1be 1at 1increased 1risk?
a. 29-year-old 1woman 1whose 1waist 1measures 133 1inches 1and 1hips 1measure 136 1inches
b. 32-year-old 1man 1whose 1waist 1measures 134 1inches 1and 1hips 1measure 136 1inches
c. 38-year-old 1man 1whose 1waist 1measures 135 1inches 1and 1hips 1measure 138 1inches
d. 46-year-old 1woman 1whose 1waist 1measures 130 1inches 1and 1hips 1measure 138 1inches
ANS: 1A
The 1waist-to-hip 1ratio 1assesses 1body 1fat 1distribution 1as 1an 1indicator 1of 1health 1risk. 1A 1waist-to-hip
1
ratio 1of 11.0 1or 1greater 1in 1men 1or 10.8 1or 1greater 1in 1women 1is 1indicative 1of 1android 1(upper 1body
1
obesity) 1and 1increasing 1risk 1for 1obesity-related 1disease 1and 1early 1death. 1The 129-year-old 1woman
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
has a waist-to-hip ratio of 0.92, which is greater than 0.8. The 32-year-old man has a waist-to-hip
ratio of 0.94; the 38-year-old man has a waist-to-hip ratio of 0.92; the 46-year-old woman has a
waist-to-hip ratio of 0.78.
20. A 150-year-old 1woman 1with 1elevated 1total 1cholesterol 1and 1triglyceride 1levels 1is 1visiting
1
the 1clinic 1to 1find 1out 1about 1her 1laboratory 1results. 1What 1would 1be 1important 1for 1the 1nurse 1to
include 1in 1patient 1teaching 1in 1relation 1to 1these 1tests?
1
a. The 1risks 1of 1undernutrition 1should 1be 1included.
b. Offer 1methods 1to 1reduce 1the 1stress 1in 1her 1life.
c. Provide 1information 1regarding 1a 1diet 1low 1in 1saturated 1fat.
d. This 1condition 1is 1hereditary; 1she 1can 1do 1nothing 1to 1change 1the 1levels.
ANS: 1C
The 1patient 1with 1elevated 1cholesterol 1and 1triglyceride 1levels 1should 1be 1taught 1about 1eating 1a
1
healthy 1diet 1that 1limits 1the 1intake 1of 1foods 1high 1in 1saturated 1fats 1or 1trans 1fats. 1Reducing
dietary 1fats 1is 1part 1of 1the 1treatment 1for 1this 1condition. 1The 1other 1responses 1are 1not 1pertinent
1
1
to 1her 1condition.
21. In 1performing 1an 1assessment 1on 1a 149-year-old 1woman 1who 1has 1imbalanced 1nutrition 1as
a 1result 1of 1dysphagia, 1which 1data 1would 1the 1nurse 1expect 1to 1find?
1
a. Increase 1in 1hair 1growth
b. Inadequate 1nutrient 1food 1intake
c. Weight 110% 1to 120% 1over 1ideal
d. Sore, 1inflamed 1buccal 1cavity
ANS: 1B
Dysphagia, 1or 1impaired 1swallowing, 1interferes 1with 1adequate 1nutrient 1intake.
Chapter 19 1The 1Integumentary 1System
1
Multiple 1Choice
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
1. A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular
skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and
reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered
across 1her 1skin. 1From 1this 1description, 1which 1of 1the 1following 1is 1not 1a 1risk 1factor 1for 1melanoma
1in 1this 1patient?
A) Age
B) Hair 1color
C) Actinic 1lentigines
D) Heavy 1sun 1exposure
Ans: 1A
Feedback: 1The 1risk 1for 1melanoma 1is 1increased 1in 1people 1over 1the 1age 1of 150; 1our 1patient 1is 135
1years 1old. 1The 1other 1answers 1represent 1known 1risk 1factors 1for 1melanoma. 1Especially 1with 1a
1family 1history 1of 1melanoma, 1she 1should 1be 1instructed 1to 1keep 1her 1skin 1covered 1when 1in 1the
1sun 1and 1use 1strong 1sunscreen 1on 1exposed 1areas.
2. You 1are 1speaking 1to 1an 18th 1grade 1class 1about 1health 1prevention 1and 1are 1preparing 1to
1discuss 1the 1ABCDEs 1of 1melanoma. 1Which 1of 1the 1following 1descriptions 1correctly 1defines 1the
1ABCDEs?
A) A 1= 1actinic; 1B 1= 1basal 1cell; 1C 1= 1color 1changes, 1especially 1blue; 1D 1= 1diameter 1>6 1mm; 1E
1= 1evolution
B) A 1= 1asymmetry; 1B 1= 1irregular 1borders; 1C 1= 1color 1changes, 1especially 1blue; 1D 1= 1diameter
1>6 1mm; 1E 1= 1evolution
C) A 1= 1actinic; 1B 1= 1irregular 1borders; 1C 1= 1keratoses; 1D 1= 1dystrophic 1nails; 1E 1= 1evolution
D) A 1= 1asymmetry; 1B 1= 1regular 1borders; 1C 1= 1color 1changes, 1especially 1orange; 1D 1= 1diameter
1>6 1mm; 1E 1= 1evolution
Ans: 1B
Feedback: 1 This 1is 1the 1correct 1description 1for 1the 1mnemonic.
3. You 1are 1beginning 1the 1examination 1of 1the 1skin 1on 1a 125-year-old 1teacher. 1You 1have
1previously 1elicited 1that 1she 1came 1to 1the 1office 1for 1evaluation 1of 1fatigue, 1weight 1gain, 1and 1hair
1loss. 1You 1strongly 1suspect 1that 1she 1has 1hypothyroidism. 1What 1is 1the 1expected 1moisture 1and
1texture 1of 1the 1skin 1of 1a 1patient 1with 1hypothyroidism?
A) Moist 1and 1smooth
B) Moist 1and 1rough
C) Dry 1and 1smooth
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
D) Dry and rough
Ans: D
Feedback: A patient with hypothyroidism is expected to have skin that is dry as well as rough.
This 1is 1a 1good 1example 1of 1how 1the 1skin 1can 1give 1clues 1to 1systemic 1diseases.
4. A 128-year-old 1patient 1comes 1to 1the 1office 1for 1evaluation 1of 1a 1rash. 1At 1first 1there 1was 1only
1one 1large 1patch, 1but 1then 1more 1lesions 1erupted 1suddenly 1on 1the 1back 1and 1torso; 1the 1lesions
1itch. 1On 1physical 1examination, 1you 1note 1that 1the 1pattern 1of 1eruption 1is 1like 1a 1Christmas 1tree
1and 1that 1there 1are 1a 1variety 1of 1erythematous 1papules 1and 1macules 1on 1the 1cleavage 1lines 1of 1the
1back. 1Based 1on 1this 1description, 1what 1is 1the 1most 1likely 1diagnosis?
A) Pityriasis 1rosea
B) Tinea 1versicolor
C) Psoriasis
D) Atopic 1eczema
Ans: 1A
Feedback: 1This 1is 1a 1classic 1description 1of 1pityriasis 1rosea. 1The 1description 1of 1a 1large 1single 1or
―herald‖ 1patch 1preceding 1the 1eruption 1is 1a 1good 1way 1to 1distinguish 1this 1rash 1from 1other
1conditions.
5. A 119-year-old 1construction 1worker 1presents 1for 1evaluation 1of 1a 1rash. 1He 1notes 1that 1it 1started
1on 1his 1back 1with 1a 1multitude 1of 1spots 1and 1is 1also 1on 1his 1arms, 1chest, 1and 1neck. 1It 1itches 1a 1lot.
1He 1does 1sweat 1more 1than 1before 1because 1being 1outdoors 1is 1part 1of 1his 1job. 1On 1physical
1examination, 1you 1note 1dark 1tan 1patches 1with 1a 1reddish 1cast 1that 1has 1sharp 1borders 1and 1fine
1scales, 1scattered 1more 1prominently 1around 1the 1upper 1back, 1chest, 1neck, 1and 1upper 1arms 1as 1well
1as 1under 1the 1arms. 1Based 1on 1this 1description, 1what 1is 1your 1most 1likely 1diagnosis?
A) Pityriasis 1rosea
B) Tinea 1versicolor
C) Psoriasis
D) Atopic 1eczema
Ans: 1B
Feedback: 1This 1is 1a 1typical 1description 1of 1tinea 1versicolor. 1The 1information 1that 1the 1patient 1is
1sweating 1more 1also 1helps 1support 1this 1diagnosis, 1because 1tinea 1is 1a 1fungal 1infection 1and 1is
1promoted 1by 1moisture.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
6. A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right
temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a
dry 1scale 1that 1is 1round 1and 1feels 1hard. 1He 1has 1several 1more 1of 1these 1scattered 1on 1the 1forehead,
1arms, 1and 1legs. 1Based 1on 1this 1description, 1what 1is 1your 1most 1likely 1diagnosis?
A) Actinic 1keratosis
B) Seborrheic 1keratosis
C) Basal 1cell 1carcinoma
D) Squamous 1cell 1carcinoma
Ans: 1A
Feedback: 1This 1is 1a 1typical 1description 1of 1actinic 1keratosis. 1Actinic 1keratosis 1may 1be 1easier 1to
1feel 1than 1to 1see. 1If 1left 1untreated, 1approximately 11% 1of 1cases 1can 1develop 1into 1squamous 1cell
1carcinoma.
7. A 158-year-old 1gardener 1comes 1to 1your 1office 1for 1evaluation 1of 1a 1new 1lesion 1on 1her
1upper 1chest. 1The 1lesion 1appears 1to 1be 1―stuck 1on‖ 1and 1is 1oval, 1brown, 1and 1slightly 1elevated
1with 1a 1flat 1surface. 1It 1has 1a 1rough, 1wartlike 1texture 1on 1palpation. 1Based 1on 1this 1description,
1what 1is 1your 1most 1likely 1diagnosis?
A) Actinic 1keratosis
B) Seborrheic 1keratosis
C) Basal 1cell 1carcinoma
D) Squamous 1cell 1carcinoma
Ans: 1B
Feedback: 1This 1is 1a 1typical 1description 1for 1seborrheic 1keratosis. 1The 1―stuck 1on‖ 1appearance
1and 1the 1rough, 1wartlike 1texture 1are 1key 1features 1for 1the 1diagnosis. 1They 1often 1produce 1a
1greasy 1scale 1when 1scratched 1with 1a 1fingernail, 1which 1further 1helps 1to 1distinguish 1them 1from
1other 1lesions.
Frequently, 1these 1benign 1lesions 1actually 1meet 1several 1of 1the 1ABCDEs 1of 1melanoma, 1so 1it 1is
1important 1to 1distinguish 1these 1lesions 1to 1prevent 1unnecessary 1biopsy. 1It 1is 1important 1to
1consider 1biopsy 1whenever 1there 1is 1any 1doubt, 1though.
8. A 172-year-old 1teacher 1comes 1to 1a 1skilled 1nursing 1facility 1for 1rehabilitation 1after 1being 1in
1the 1hospital 1for 16 1weeks. 1She 1was 1treated 1for 1sepsis 1and 1respiratory 1failure 1and 1had 1to 1be 1on
1the 1ventilator 1for 13 1weeks. 1You 1are 1completing 1your 1initial 1assessment 1and 1are 1evaluating
1her 1skin 1condition. 1On 1her 1sacrum 1there 1is 1full-thickness 1skin 1loss 1that 1is 15 1cm 1in 1diameter,
1with 1damage
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a
pressure ulcer. What is the stage of this ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) 1Stage 14
Ans: 1C
Feedback: 1A 1stage 13 1ulcer 1is 1a 1full-thickness 1skin 1loss 1with 1damage 1to 1or 1necrosis 1of
1subcutaneous 1tissue 1that 1may 1extend 1to, 1but 1not 1through, 1the 1underlying 1muscle.
9. An 18-year-old 1girl 1comes 1with 1her 1mother 1for 1evaluation 1of 1hair 1loss. 1She 1denies 1pulling 1or
1twisting 1her 1hair, 1and 1her 1mother 1has 1not 1noted 1this 1behavior 1at 1all. 1She 1does 1not 1put 1her 1hair
1in 1braids. 1On 1physical 1examination, 1you 1note 1a 1clearly 1demarcated, 1round 1patch 1of 1hair 1loss
1without 1visible 1scaling 1or 1inflammation. 1There 1are 1no 1hair 1shafts 1visible. 1Based 1on 1this
1description, 1what 1is 1your 1most 1likely 1diagnosis?
A) Alopecia 1areata
B) Trichotillomania
C) Tinea 1capitis
D) Traction 1alopecia
Ans: 1A
Feedback: 1This 1is 1a 1typical 1description 1for 1alopecia 1areata. 1There 1are 1no 1risk 1factors 1for
1trichotillomania 1or 1for 1traction 1alopecia. 1The 1physical 1examination 1is 1not 1consistent 1with 1tinea
1capitis 1because 1the 1skin 1is 1intact.
10. A 1mother 1brings 1her 111 1month 1old 1to 1you 1because 1her 1mother-in-law 1and 1others 1have 1told
1her 1that 1her 1baby 1is 1jaundiced. 1She 1is 1eating 1and 1growing 1well 1and 1performing 1the
1developmental 1milestones 1she 1should 1for 1her 1age. 1On 1examination 1you 1indeed 1notice 1a 1yellow
1tone 1to 1her 1skin 1from 1head 1to 1toe. 1 Her 1sclerae 1are 1white. 1 To 1which 1area 1should 1your 1next
1questions 1be 1related?
A) Diet
B) Family 1history 1of 1liver 1diseases
C) Family 1history 1of 1blood 1diseases
D) Ethnicity 1of 1the 1child
Ans: 1A
Feedback: 1The 1lack 1of 1jaundice 1in 1the 1sclerae 1is 1an 1important 1clue. 1Typically, 1this 1is 1the 1first
1place 1where 1one 1sees 1jaundice. 1 This 1examination 1should 1also 1be 1carried 1out 1in 1natural 1light
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
(sunlight) as opposed to fluorescent lighting, which can alter perceived colors. Many infants this
age have a large proportion of carrots, tomatoes, and yellow squash, which are rich in carotene.
Liver and blood diseases can cause jaundice, but this should involve the sclerae. The ethnicity of
the child should not cause a perceived change from her usual skin tone.
11. A 1new 1mother 1is 1concerned 1that 1her 1child 1occasionally 1―turns 1blue.‖ 1On 1further
1questioning, 1she 1mentions 1that 1this 1is 1at 1her 1hands 1and 1feet. 1She 1does 1not 1remember 1the
1child's 1lips 1turning 1blue. 1She 1is 1otherwise 1eating 1and 1growing 1well. 1 What 1would 1you 1do
1now?
A) Reassure 1her 1that 1this 1is 1normal
B) Obtain 1an 1echocardiogram 1to 1check 1for 1structural 1heart 1disease 1and 1consult 1cardiology
C) Admit 1the 1child 1to 1the 1hospital 1for 1further 1observation
D) Question 1the 1validity 1of 1her 1story
Ans: 1A
Feedback: 1This 1is 1an 1example 1of 1peripheral 1cyanosis. 1This 1is 1a 1very 1common 1and 1benign
1condition 1which 1typically 1occurs 1when 1the 1child 1is 1slightly 1cold 1and 1his 1peripheral 1circulation
1is 1adjusting 1to 1keep 1his 1core 1warm. 1 Without 1other 1problems, 1there 1is 1no 1need 1for 1further
1workup. 1 If 1the 1lips 1or 1other 1central 1locations 1are 1involved, 1you 1must 1consider 1other 1etiologies.
12. You 1are 1examining 1an 1unconscious 1patient 1from 1another 1region 1and 1notice 1Beau's 1lines,
1a 1transverse 1groove 1across 1all 1of 1her 1nails, 1about 11 1cm 1from 1the 1proximal 1nail 1fold. 1What
1would 1you 1do 1next?
A) Conclude 1this 1is 1caused 1by 1a 1cultural 1practice.
B) Conclude 1this 1finding 1is 1most 1likely 1secondary 1to 1trauma.
C) Look 1for 1information 1from 1family 1and 1records 1regarding 1any 1problems 1which 1occurred
13 1months 1ago.
D) Ask 1about 1dietary 1intake.
Ans: 1C
Feedback: 1These 1lines 1can 1provide 1valuable 1information 1about 1previous 1significant 1illnesses,
1some 1of 1which 1are 1forgotten 1or 1are 1not 1able 1to 1be 1reported 1by 1the 1patient. 1Because 1the
1fingernails 1grow 1at 1about 10.1 1mm 1per 1day, 1you 1would 1ask 1about 1an 1illness 1100 1days 1ago. 1This
1patient 1may 1have 1been 1hospitalized 1for 1endocarditis 1or 1may 1have 1had 1another 1significant 1illness
1which 1should 1be 1sought. 1Trauma 1to 1all 110 1nails 1in 1the 1same 1location 1is 1unlikely. 1Dietary
1intake 1at 1this 1time 1would 1not 1be 1related 1to 1this 1finding. 1Do 1not 1assume 1a 1finding 1is 1necessarily
1related 1to 1a 1patient's 1culture 1unless 1you 1have 1good 1knowledge 1of 1that 1culture.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
13. Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of
exposure to ill people or other agents in the environment. He has a slight fever in the office. The
rash consists of small, bright red marks. When they are pressed, the red color remains. What
should 1you 1do?
A) Prescribe 1a 1steroid 1cream 1to 1decrease 1inflammation.
B) Consider 1admitting 1the 1patient 1to 1the 1hospital.
C) Reassure 1the 1parents 1and 1the 1patient 1that 1this 1should 1resolve 1within 1a 1week.
D) Tell 1him 1not 1to 1scratch 1them, 1and 1follow 1up 1in 13 1days.
Ans: 1B
Feedback: 1Although 1this 1may 1not 1be 1an 1impressive 1rash, 1the 1fact 1that 1they 1do 1not 1―blanch‖
1with 1pressure 1is 1very 1concerning. 1This 1generally 1means 1that 1there 1is 1pinpoint 1bleeding 1under
1the 1skin, 1and 1while 1this 1can 1be 1benign, 1it 1can 1be 1associated 1with 1life-threatening 1illnesses 1like
1meningococcemia 1and 1low 1platelet 1counts 1(thrombocytopenia) 1associated 1with 1serious 1blood
1disorders 1like 1leukemia. 1You 1should 1always 1report 1this 1feature 1of 1a 1rash 1immediately 1to 1a
1supervisor 1or 1teacher.
14. Mrs. 1Hill 1is 1a 128-year-old 1African-American 1with 1a 1history 1of 1SLE 1(systemic 1lupus
1erythematosus). 1She 1has 1noticed 1a 1raised, 1dark 1red 1rash 1on 1her 1legs. 1When 1you 1press 1on 1the
1rash, 1it 1doesn't 1blanch. 1What 1would 1you 1tell 1her 1regarding 1her 1rash?
A) It 1is 1likely 1to 1be 1related 1to 1her 1lupus.
B) It 1is 1likely 1to 1be 1related 1to 1an 1exposure 1to 1a 1chemical.
C) It 1is 1likely 1to 1be 1related 1to 1an 1allergic 1reaction.
D) It 1should 1not 1cause 1any 1problems.
Ans: 1A
Feedback: 1A 1―palpable 1purpura‖ 1is 1usually 1associated 1with 1a 1vasculitis. 1This 1is 1an
1inflammatory 1condition 1of 1the 1blood 1vessels 1often 1associated 1with 1systemic 1rheumatic
1disease. 1It 1can 1cut 1off 1circulation 1to 1any 1portion 1of 1the 1body 1and 1can 1mimic 1many 1other
1diseases 1in 1this 1manner. 1While 1allergic 1and 1chemical 1exposures 1may 1be 1a 1possible 1cause 1of
1the 1rash, 1this 1patient's 1SLE 1should 1make 1you 1consider 1vasculitis.
15. Jacob, 1a 133-year-old 1construction 1worker, 1complains 1of 1a 1―lump 1on 1his 1back‖ 1over 1his
1scapula. 1It 1has 1been 1there 1for 1about 1a 1year 1and 1is 1getting 1larger. 1 He 1says 1his 1wife 1has 1been
1able 1to 1squeeze 1out 1a 1cheesy-textured 1substance 1on 1occasion. 1He 1worries 1this 1may 1be 1cancer.
1When 1gently 1pinched 1from 1the 1side, 1a 1prominent 1dimple 1forms 1in 1the 1middle 1of 1the 1mass.
1What 1is 1most
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
likely?
A) An enlarged lymph node
B) A sebaceous cyst
C) An actinic keratosis
D) A malignant lesion
Ans: 1B
Feedback: 1This 1is 1a 1classic 1description 1of 1an 1epidermal 1inclusion 1cyst 1resulting 1from 1a
1blocked 1sebaceous 1gland. 1The 1fact 1that 1any 1lesion 1is 1enlarging 1is 1worrisome, 1but 1the 1other
1descriptors 1are 1so 1distinctive 1that 1cancer 1is 1highly 1unlikely. 1 This 1would 1be 1an 1unusual
1location 1for 1a 1lymph 1node, 1and 1these 1do 1not 1usually 1drain 1to 1the 1skin.
16. A 1young 1man 1comes 1to 1you 1with 1an 1extremely 1pruritic 1rash 1over 1his 1knees 1and 1elbows
1which 1has 1come 1and 1gone 1for 1several 1years. 1It 1seems 1to 1be 1worse 1in 1the 1winter 1and 1improves
1with 1some 1sun 1exposure. 1On 1examination, 1you 1notice 1scabbing 1and 1crusting 1with 1some 1silvery
1scale, 1and 1you 1are 1observant 1enough 1to 1notice 1small 1―pits‖ 1in 1his 1nails. 1What 1would 1account
1for 1these 1findings?
A) Eczema
B) Pityriasis 1rosea
C) Psoriasis
D) Tinea 1infection
Ans: 1C
Feedback: 1This 1is 1a 1classic 1presentation 1of 1plaque 1psoriasis. 1Eczema 1is 1usually 1over 1the 1flexor
1surfaces 1and 1does 1not 1scale, 1whereas 1psoriasis 1affects 1the 1extensor 1surfaces. 1Pityriasis 1usually
1is 1limited 1to 1the 1trunk 1and 1proximal 1extremities. 1Tinea 1has 1a 1much 1finer 1scale 1associated 1with
1it, 1almost 1like 1powder, 1and 1is 1found 1in 1dark 1and 1moist 1areas.
17. Mrs. 1Anderson 1presents 1with 1an 1itchy 1rash 1which 1is 1raised 1and 1appears 1and 1disappears 1in
1various 1locations. 1 Each 1lesion 1lasts 1for 1many 1minutes. 1 What 1most 1likely 1accounts 1for 1this
1rash?
A) Insect 1bites
B) Urticaria, 1or 1hives
C) Psoriasis
D) Purpura
Ans: 1B
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: This is a typical case of urticaria. The most unusual aspect of this condition is that
the lesions ―move‖ from place to place. This would be distinctly unusual for the other causes
listed.
18. Ms. 1Whiting 1is 1a 168 1year 1old 1who 1comes 1in 1for 1her 1usual 1follow-up 1visit. 1You 1notice 1a
1few 1flat 1red 1and 1purple 1lesions, 1about 16 1centimeters 1in 1diameter, 1on 1the 1ulnar 1aspect 1of 1her
1forearms 1but 1nowhere 1else. 1She 1doesn't 1mention 1them. 1They 1are 1tender 1when 1you 1examine
1them. 1What 1should 1you 1do?
A) Conclude 1that 1these 1are 1lesions 1she 1has 1had 1for 1a 1long 1time.
B) Wait 1for 1her 1to 1mention 1them 1before 1asking 1further 1questions.
C) Ask 1how 1she 1acquired 1them.
D) Conduct 1the 1visit 1as 1usual 1for 1the 1patient.
Ans: 1C
Feedback: 1These 1are 1consistent 1with 1ecchymoses, 1or 1bruises. 1It 1is 1important 1to 1ask 1about
1antiplatelet 1medications 1such 1as 1aspirin, 1trauma 1history, 1and 1history 1of 1blood 1disorders 1in 1the
1patient 1and 1her 1family. 1Because 1of 1the 1different 1ages 1of 1the 1bruises 1and 1the 1isolation 1of 1them
1to 1the 1ulnar 1forearms, 1these 1may 1be 1a 1result 1of 1abuse 1or 1other 1violence. 1It 1is 1your 1duty 1to
1investigate 1the 1cause 1of 1these 1lesions.
19. A 1middle-aged 1man 1comes 1in 1because 1he 1has 1noticed 1multiple 1small, 1blood-red, 1raised
1lesions 1over 1his 1anterior 1chest 1and 1abdomen 1for 1the 1past 1several 1months. 1They 1are 1not
1painful 1and 1he 1has 1not 1noted 1any 1bleeding 1or 1bruising. 1He 1is 1concerned 1this 1may 1be
1consistent 1with 1a 1dangerous 1condition. 1 What 1should 1you 1do?
A) Reassure 1him 1that 1there 1is 1nothing 1to 1worry 1about.
B) Do 1laboratory 1work 1to 1check 1for 1platelet 1problems.
C) Obtain 1an 1extensive 1history 1regarding 1blood 1problems 1and 1bleeding 1disorders.
D) Do 1a 1skin 1biopsy 1in 1the 1office.
Ans: 1A
Feedback: 1These 1represent 1cherry 1angiomas, 1which 1are 1very 1common, 1benign 1lesions. 1Further
1workup 1such 1as 1laboratory 1work, 1skin 1biopsy, 1or 1even 1further 1questions 1are 1not 1necessary 1at
1this 1time. 1It 1would 1be 1wise 1to 1ask 1the 1patient 1to 1report 1any 1changes 1in 1any 1of 1his 1skin 1lesions,
1and 1tell 1him 1that 1you 1would 1need 1to 1see 1him 1at 1that 1time.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Chapter 10 The Head and Neck
Multiple Choice
1. A 138-year-old 1accountant 1comes 1to 1your 1clinic 1for 1evaluation 1of 1a 1headache. 1The
1throbbing 1sensation 1is 1located 1in 1the 1right 1temporal 1region 1and 1is 1an 18 1on 1a 1scale 1of 11 1to 110. 1It
1started 1a 1few 1hours 1ago, 1and 1she 1has 1noted 1nausea 1with 1sensitivity 1to 1light; 1she 1has 1had
1headaches 1like 1this 1in 1the 1past, 1usually 1less 1than 1one 1per 1week, 1but 1not 1as 1severe. 1She 1does
1not 1know 1of 1any 1inciting 1factors. 1There 1has 1been 1no 1change 1in 1the 1frequency 1of 1her
1headaches. 1She 1usually 1takes 1an 1over- 1the-counter 1analgesic 1and 1this 1results 1in 1resolution 1of
1the 1headache. 1Based 1on 1this 1description, 1what 1is 1the 1most 1likely 1diagnosis 1of 1the 1type 1of
1headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic 1rebound
Ans: 1B
Feedback: 1This 1is 1a 1description 1of 1a 1common 1migraine 1(no 1aura). 1Distinctive 1features 1of 1a
1migraine 1include 1phonophobia 1and 1photophobia, 1nausea, 1resolution 1with 1sleep, 1and 1unilateral
1distribution. 1 Only 1some 1of 1these 1features 1may 1be 1present.
2. A 129-year-old 1computer 1programmer 1comes 1to 1your 1office 1for 1evaluation 1of 1a 1headache.
1The 1tightening 1sensation 1is 1located 1all 1over 1the 1head 1and 1is 1of 1moderate 1intensity. 1It 1used 1to
1last 1minutes, 1but 1this 1time 1it 1has 1lasted 1for 15 1days. 1He 1denies 1photophobia 1and 1nausea. 1He
1spends 1several 1hours 1each 1day 1at 1a 1computer 1monitor/keyboard. 1He 1has 1tried 1over-thecounter 1medication; 1it 1has 1dulled 1the 1pain 1but 1not 1taken 1it 1away. 1Based 1on 1this 1description,
1what 1is 1your 1most 1likely 1diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic 1rebound
Ans: 1A
Feedback: 1 This 1is 1a 1description 1of 1a 1typical 1tension 1headache.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
3. Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) 1 Rhinorrhea
Ans: 1A
Feedback: 1Scotomas 1are 1specks 1in 1the 1vision 1or 1areas 1where 1the 1patient 1cannot 1see; 1therefore,
1this 1is 1a 1common/concerning 1symptom 1of 1the 1eye.
4. A 149-year-old 1administrative 1assistant 1comes 1to 1your 1office 1for 1evaluation 1of 1dizziness. 1You
1elicit 1the 1information 1that 1the 1dizziness 1is 1a 1spinning 1sensation 1of 1sudden 1onset, 1worse 1with
1head 1position 1changes. 1The 1episodes 1last 1a 1few 1seconds 1and 1then 1go 1away, 1and 1they 1are
1accompanied 1by 1intense 1nausea. 1She 1has 1vomited 1one 1time. 1She 1denies 1tinnitus. 1You 1perform
1a 1physical 1examination 1of 1the 1head 1and 1neck 1and 1note 1that 1the 1patient's 1hearing 1is 1intact 1to
1Weber 1and 1Rinne 1and 1that 1there 1is 1nystagmus. 1Her 1gait 1is 1normal. 1Based 1on 1this 1description,
1what 1is 1the 1most 1likely 1diagnosis?
A) Benign 1positional 1vertigo
B) Vestibular 1neuronitis
C) Ménière's 1disease
D) Acoustic 1neuroma
Ans: 1A
Feedback: 1This 1is 1a 1classic 1description 1of 1benign 1positional 1vertigo. 1The 1vertigo 1is 1episodic,
1lasting 1a 1few 1seconds 1to 1minutes, 1instead 1of 1continuous 1as 1in 1vestibular 1neuronitis. 1Also, 1there
1is 1no 1tinnitus 1or 1sensorineural 1hearing 1loss 1as 1occurs 1in 1Ménière's 1disease 1and 1acoustic
1neuroma.
You 1may 1choose 1to 1learn 1about 1Hallpike 1maneuvers, 1which 1are 1also 1helpful 1in 1the 1evaluation
1of 1vertigo.
5. A 155-year-old 1bank 1teller 1comes 1to 1your 1office 1for 1persistent 1episodes 1of 1dizziness. 1The 1first
1episode 1started 1suddenly 1and 1lasted 13 1to 14 1hours. 1He 1experienced 1a 1lot 1of 1nausea 1with
1vomiting; 1the 1episode 1resolved 1spontaneously. 1He 1has 1had 1five 1episodes 1in 1the 1past 11½ 1weeks.
1He 1does 1note 1some 1tinnitus 1that 1comes 1and 1goes. 1Upon 1physical 1examination, 1you 1note 1that 1he
1has 1a 1normal 1gait. 1The 1Weber 1localizes 1to 1the 1right 1side 1and 1the 1air 1conduction 1is 1equal 1to 1the
1bone 1conduction 1in 1the 1right 1ear. 1Nystagmus 1is 1present. 1Based 1on 1this 1description, 1what 1is 1the
1most 1likely 1diagnosis?
A) Benign 1positional 1vertigo
B) Vestibular 1neuronitis
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
C) Ménière's disease
D) Acoustic neuroma
Ans: C
Feedback: 1Ménière's 1disease 1is 1characterized 1by 1sudden 1onset 1of 1vertiginous 1episodes 1that 1last
1several 1hours 1to 1a 1day 1or 1more, 1then 1spontaneously 1resolve; 1the 1episodes 1then 1recur. 1On 1physical
1examination, 1sensorineural 1hearing 1loss 1is 1present. 1The 1patient 1does 1complain 1of 1tinnitus.
6. A 173-year-old 1nurse 1comes 1to 1your 1office 1for 1evaluation 1of 1new 1onset 1of 1tremors. 1She 1is 1not
1on 1any 1medications 1and 1does 1not 1take 1herbs 1or 1supplements. 1She 1has 1no 1chronic 1medical
1conditions. 1She 1does 1not 1smoke 1or 1drink 1alcohol. 1She 1walks 1into 1the 1examination 1room 1with
1slow 1movements 1and 1shuffling 1steps. 1She 1has 1decreased 1facial 1mobility 1and 1a 1blunt
1expression, 1without 1any 1changes 1in 1hair 1distribution 1on 1her 1face. 1Based 1on 1this 1description,
1what 1is 1the 1most 1likely 1reason 1for 1the 1patient's 1symptoms?
A) Cushing's 1syndrome
B) Nephrotic 1syndrome
C) Myxedema
D) Parkinson's 1disease
Ans: 1D
Feedback: 1This 1is 1a 1typical 1description 1for 1a 1patient 1with 1Parkinson's 1disease. 1Facial 1mobility
1is 1decreased, 1which 1results 1in 1a 1blunt 1expression—a 1―masked‖ 1appearance. 1The 1patient 1also
1has 1decreased 1blinking 1and 1a 1characteristic 1stare 1with 1an 1upward 1gaze. 1In 1combination 1with
1the 1findings 1of 1slow 1movements 1and 1a 1shuffling 1gait, 1the 1diagnosis 1of 1Parkinson's 1is 1almost
1clinched.
7. A 129-year-old 1physical 1therapist 1presents 1for 1evaluation 1of 1an 1eyelid 1problem. 1On
1observation, 1the 1right 1eyeball 1appears 1to 1be 1protruding 1forward. 1Based 1on 1this 1description,
1what 1is 1the 1most 1likely 1diagnosis?
A) Ptosis
B) Exophthalmos
C) Ectropion
D) Epicanthus
Ans: 1B
Feedback: 1Exophthalmos 1is 1the 1condition 1when 1the 1eyeball 1protrudes 1forward. 1If 1it 1is 1bilateral,
1it 1suggests 1the 1presence 1of 1Graves' 1disease. 1If 1it 1is 1unilateral, 1it 1could 1still 1be 1caused 1by
1Graves' 1disease. 1 Alternatively, 1it 1could 1be 1caused 1by 1a 1tumor 1or 1inflammation 1in 1the 1orbit.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
8. A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left
eye. 1It 1started 1this 1morning. 1He 1denies 1any 1trauma 1or 1injury. 1There 1is 1no 1visual 1disturbance.
1Upon 1physical 1examination, 1there 1is 1a 1red 1raised 1area 1at 1the 1margin 1of 1the 1eyelid 1that 1is 1tender
1to 1palpation; 1no 1tearing 1occurs 1with 1palpation 1of 1the 1lesion. 1Based 1on 1this 1description, 1what 1is
1the 1most 1likely 1diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma
Ans: 1C
Feedback: 1A 1hordeolum, 1or 1sty, 1is 1a 1painful, 1tender, 1erythematous 1infection 1in 1a 1gland 1at 1the
1margin 1of 1the 1eyelid.
9. A 115-year-old 1high 1school 1sophomore 1presents 1to 1the 1emergency 1room 1with 1his 1mother 1for
1evaluation 1of 1an 1area 1of 1blood 1in 1the 1left 1eye. 1He 1denies 1trauma 1or 1injury 1but 1has 1been
1coughing 1forcefully 1with 1a 1recent 1cold. 1He 1denies 1visual 1disturbances, 1eye 1pain, 1or 1discharge
1from 1the 1eye. 1On 1physical 1examination, 1the 1pupils 1are 1equal, 1round, 1and 1reactive 1to 1light, 1with
1a 1visual 1acuity 1of 120/20 1in 1each 1eye 1and 120/20 1bilaterally. 1There 1is 1a 1homogeneous, 1sharply
1demarcated 1area 1at 1the 1lateral 1aspect 1of 1the 1base 1of 1the 1left 1eye. 1The 1cornea 1is 1clear. 1Based 1on
1this 1description, 1what 1is 1 the 1most 1likely 1diagnosis?
A) Conjunctivitis
B) Acute 1iritis
C) Corneal 1abrasion
D) Subconjunctival 1hemorrhage
Ans: 1D
Feedback: 1A 1subconjunctival 1hemorrhage 1is 1a 1leakage 1of 1blood 1outside 1of 1the 1vessels, 1which
1produces 1a 1homogenous, 1sharply 1demarcated 1bright 1red 1area; 1it 1fades 1over 1several 1days,
1turning 1yellow, 1then 1disappears. 1There 1is 1no 1associated 1eye 1pain, 1ocular 1discharge, 1or
1changes 1in 1visual 1acuity; 1the 1cornea 1is 1clear. 1Many 1times 1it 1is 1associated 1with 1severe 1cough,
1choking, 1or 1vomiting, 1which 1increase 1venous 1pressure. 1It 1is 1rarely 1caused 1by 1a 1serious
1condition, 1so 1reassurance 1is 1usually 1the 1only 1treatment 1necessary.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
10. A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history
of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular
thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal
pupillary reaction to light and accommodation. Based on this description, what is the most likely
diagnosis?
A) Corneal 1arcus
B) Cataracts
C) Corneal 1scar
D) Pterygium
Ans: 1D
Feedback: 1A 1pterygium 1is 1a 1triangular 1thickening 1of 1the 1bulbar 1conjunctiva 1that 1grows 1slowly
1across 1the 1outer 1surface 1of 1the 1cornea, 1usually 1from 1the 1nasal 1side. 1Reddening 1may 1occur, 1and
1it 1may 1interfere 1with 1vision 1as 1it 1encroaches 1on 1the 1pupil. 1 Otherwise, 1treatment 1is
1unnecessary.
11. Which 1of 1the 1following 1is 1a 1―red 1flag‖ 1regarding 1patients 1presenting 1with 1headache?
A) Unilateral 1headache
B) Pain 1over 1the 1sinuses
C) Age 1over 150
D) Phonophobia 1and 1photophobia
Ans: 1C
Feedback: 1A 1unilateral 1headache 1is 1often 1seen 1with 1migraines 1and 1may 1commonly 1be
1accompanied 1by 1phonophobia 1and 1photophobia. 1Pain 1over 1the 1sinuses 1from 1sinus 1congestion
1may 1also 1be 1unilateral 1and 1produce 1pain. 1Migraine 1and 1sinus 1headaches 1are 1common 1and
1generally 1benign. 1A 1new 1severe 1headache 1in 1someone 1over 150 1can 1be 1associated 1with 1more
1serious 1etiologies 1for 1headache. 1 Other 1red 1flags 1include: 1acute 1onset, 1―the 1worst 1headache 1of
1my 1life‖; 1very 1high 1blood 1pressure; 1rash 1or 1signs 1of 1infection; 1known 1presence 1of 1cancer,
1HIV, 1or 1pregnancy; 1vomiting; 1recent 1head 1trauma; 1and 1persistent 1neurologic 1problems.
12. A 1sudden, 1painless 1unilateral 1vision 1loss 1may 1be 1caused 1by 1which 1of 1the 1following?
A) Retinal 1detachment
B) Corneal 1ulcer
C) Acute 1glaucoma
D) Uveitis
Ans: 1A
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain.
Retinal detachment is generally painless, as is chronic glaucoma.
13. Sudden, 1painful 1unilateral 1loss 1of 1vision 1may 1be 1caused 1by 1which 1of 1the
1following 1conditions?
A) Vitreous 1hemorrhage
B) Central 1retinal 1artery 1occlusion
C) Macular 1degeneration
D) Optic 1neuritis
Ans: 1D
Feedback: 1In 1multiple 1sclerosis, 1sudden 1painful 1loss 1of 1vision 1may 1accompany 1optic 1neuritis.
1The 1other 1conditions 1are 1usually 1painless.
14. Diplopia, 1which 1is 1present 1with 1one 1eye 1covered, 1can 1be 1caused 1by 1which 1of 1the
1following 1problems?
A) Weakness 1of 1CN 1III
B) Weakness 1of 1CN 1IV
C) A 1lesion 1of 1the 1brainstem
D) An 1irregularity 1in 1the 1cornea 1or 1lens
Ans: 1D
Feedback: 1Double 1vision 1in 1one 1eye 1alone 1points 1to 1a 1problem 1in 1―processing‖ 1the 1light 1rays 1of
1an 1incoming 1image. 1 The 1other 1causes 1of 1diplopia 1result 1in 1a 1misalignment 1of 1the 1two 1eyes.
15. A 1patient 1complains 1of 1epistaxis. 1 Which 1other 1cause 1should 1be 1considered?
A) Intracranial 1hemorrhage
B) Hematemesis
C) Intestinal 1hemorrhage
D) Hematoma 1of 1the 1nasal 1septum
Ans: 1B
Feedback: 1Although 1the 1source 1of 1epistaxis 1may 1seem 1obvious, 1other 1bleeding 1locations 1should
1be 1on 1the 1differential. 1 Hematemesis 1can 1mimic 1this 1and 1cause 1delay 1in 1life-saving 1therapies
1if
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
not considered. Intracranial hemorrhage and septal hematoma are instances of contained
bleeding. Intestinal hemorrhage may cause hematemesis if there is obstruction distal to the
bleeding, but this is unlikely.
16. Glaucoma 1is 1the 1leading 1cause 1of 1blindness 1in 1African-Americans 1and 1the 1second
1leading 1cause 1of 1blindness 1overall. 1 What 1features 1would 1be 1noted 1on 1funduscopic
1examination?
A) Increased 1cup-to-disc 1ratio
B) AV 1nicking
C) Cotton 1wool 1spots
D) Microaneurysms
Ans: 1A
Feedback: 1It 1is 1important 1to 1screen 1for 1glaucoma 1on 1funduscopic 1examination. 1The 1cup 1and
1disc 1are 1among 1the 1easiest 1features 1to 1find. 1AV 1nicking 1and 1cotton 1wool 1spots 1are 1seen 1in
1hypertension. 1 Microaneurysms 1are 1seen 1in 1diabetes.
17. Very 1sensitive 1methods 1for 1detecting 1hearing 1loss 1include 1which 1of 1the 1following?
A) The 1whisper 1test
B) The 1finger 1rub 1test
C) The 1tuning 1fork 1test
D) Audiometric 1testing
Ans: 1D
Feedback: 1While 1it 1is 1important 1to 1screen 1for 1hearing 1complaints 1with 1methods 1available 1to
1you, 1it 1should 1be 1realized 1that 1some 1physical 1examination 1techniques 1are 1limited.
1Nonetheless, 1you 1should 1be 1comfortable 1performing 1these 1tests, 1as 1audiometric 1testing 1is 1not
1always 1available.
18. Which 1area 1of 1the 1fundus 1is 1the 1central 1focal 1point 1for 1incoming 1images?
A) The 1fovea
B) The 1macula
C) The 1optic 1disk
D) The 1physiologic 1cup
Ans: 1A
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Feedback: The fovea is the area of the retina which is responsible for central vision. It is
surrounded by the macula, which is responsible for more peripheral vision. The optic disc and
physiologic cup are where the optic nerve enters the eye.
19. A 1light 1is 1pointed 1at 1a 1patient's 1pupil, 1which 1contracts. 1It 1is 1also 1noted 1that 1the 1other
1pupil 1contracts 1as 1well, 1though 1it 1is 1not 1exposed 1to 1bright 1light. 1Which 1of 1the 1following
1terms 1describes 1this 1latter 1phenomenon?
A) Direct 1reaction
B) Consensual 1reaction
C) Near 1reaction
D) Accommodation
Ans: 1B
Feedback: 1The 1constriction 1of 1the 1contralateral 1pupil 1is 1called 1the 1consensual 1reaction. 1The
1response 1of 1the 1ipsilateral 1eye 1is 1the 1direct 1response. 1The 1dilation 1of 1the 1pupil 1when 1focusing
1on 1a 1close 1object 1is 1the 1near 1reaction. 1Accommodation 1is 1the 1changing 1of 1the 1shape 1of 1the
1lens 1to 1sharply 1focus 1on 1an 1object.
20. A 1patient 1is 1assigned 1a 1visual 1acuity 1of 120/100 1in 1her 1left 1eye. 1Which 1of 1the 1following
1is 1true?
A) She 1obtains 1a 120% 1correct 1score 1at 1100 1feet.
B) She 1can 1accurately 1name 120% 1of 1the 1letters 1at 120 1feet.
C) She 1can 1see 1at 120 1feet 1what 1a 1normal 1person 1could 1see 1at 1100 1feet.
D) She 1can 1see 1at 1100 1feet 1what 1a 1normal 1person 1could 1see 1at 120 1feet.
Ans: 1C
Feedback: 1The 1denominator 1of 1an 1acuity 1score 1represents 1the 1line 1on 1the 1chart 1the 1patient 1can
1read. 1In 1the 1example 1above, 1the 1patient 1could 1read 1the 1larger 1letters 1corresponding 1with 1what 1a
1normal 1person 1could 1see 1at 1100 1feet.
21. On 1visual 1confrontation 1testing, 1a 1stroke 1patient 1is 1unable 1to 1see 1your 1fingers 1on 1his
1entire 1right 1side 1with 1either 1eye 1covered. 1 Which 1of 1the 1following 1terms 1would 1describe 1this
1finding?
A) Bitemporal 1hemianopsia
B) Right 1temporal 1hemianopsia
C) Right 1homonymous 1hemianopsia
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D) Binasal hemianopsia
Ans: C
Feedback: Because the right visual field in both eyes is affected, this is a right homonymous
hemianopsia. 1A 1bitemporal 1hemianopsia 1refers 1to 1loss 1of 1both 1lateral 1visual 1fields. 1A 1right
1temporal 1hemianopsia 1is 1unilateral 1and 1binasal 1hemianopsia 1is 1the 1loss 1of 1the 1nasal 1visual
1fields 1bilaterally.
22. You 1note 1that 1a 1patient 1has 1anisocoria 1on 1examination. 1Pathologic 1causes 1of 1this
1include 1which 1of 1the 1following?
A) Horner's 1syndrome
B) Benign 1anisocoria
C) Differing 1light 1intensities 1for 1each 1eye
D) Eye 1prosthesis
Ans: 1A
Feedback: 1Anisocoria 1can 1be 1associated 1with 1serious 1pathology. 1Remember 1to 1exclude 1benign
1causes 1before 1embarking 1on 1an 1intensive 1workup. 1 Testing 1the 1near 1reaction 1in 1this 1case 1may 1help
1you 1to 1find 1an 1Argyll 1Robertson 1or 1tonic 1(Adie's) 1pupil.
23. A 1patient 1is 1examined 1with 1the 1ophthalmoscope 1and 1found 1to 1have 1red 1reflexes
1bilaterally. 1Which 1of 1the 1following 1have 1you 1essentially 1excluded 1from 1your 1differential?
A) Retinoblastoma
B) Cataract
C) Artificial 1eye
D) Hypertensive 1retinopathy
Ans: 1D
Feedback: 1Hypertensive 1retinopathy 1requires 1a 1careful 1examination 1of 1the 1optic 1fundus. 1It
1cannot 1be 1diagnosed 1or 1excluded 1merely 1from 1the 1red 1reflex. 1 Typically, 1the 1red 1reflex 1would
1be 1normal 1in 1this 1case. 1 The 1other 1conditions 1are 1all 1associated 1with 1an 1abnormal 1red 1reflex.
24. A 1patient 1presents 1with 1ear 1pain. 1She 1is 1an 1avid 1swimmer. 1The 1history 1includes 1pain 1and
1drainage 1from 1the 1left 1ear. 1On 1examination, 1she 1has 1pain 1when 1the 1ear 1is 1manipulated,
1including
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manipulation of the tragus. The canal is narrowed and erythematous, with some white debris in
the canal. The rest of the examination is normal. What diagnosis would you assign this patient?
A) Otitis media
B) External otitis
C) Perforation of the tympanum
D) 1 Cholesteatoma
Ans: 1B
Feedback: 1These 1are 1classic 1history 1and 1examination 1findings 1for 1a 1patient 1suffering 1from
1external 1otitis. 1Otitis 1media 1would 1not 1usually 1have 1pain 1with 1movement 1of 1the 1external 1ear,
1nor 1drainage 1unless 1the 1eardrum 1was 1perforated. 1In 1this 1case 1the 1examination 1of 1the 1eardrum
1is 1recorded 1as 1normal. 1Cholesteatoma 1is 1a 1growth 1behind 1the 1eardrum 1and 1would 1not 1account
1for 1these 1symptoms. 1Otitis 1media 1would 1classically 1be 1accompanied 1by 1a 1bulging,
1erythematous 1eardrum.
25. A 1patient 1with 1hearing 1loss 1by 1whisper 1test 1is 1further 1examined 1with 1a 1tuning 1fork, 1using
1the 1Weber 1and 1Rinne 1maneuvers. 1The 1abnormal 1results 1are 1as 1follows: 1bone 1conduction 1is
1greater 1than 1air 1on 1the 1left, 1and 1the 1patient 1hears 1the 1sound 1of 1the 1tuning 1fork 1better 1on 1the
1left. 1Which 1of 1the 1following 1is 1most 1likely?
A) Otosclerosis 1of 1the 1left 1ear
B) Exposure 1to 1chronic 1loud 1noise 1of 1the 1right 1ear
C) Otitis 1media 1of 1the 1right 1ear
D) Perforation 1of 1the 1right 1eardrum
Ans: 1A
Feedback: 1The 1above 1pattern 1is 1consistent 1with 1a 1conductive 1loss 1on 1the 1left 1side. 1Causes
1would 1include: 1foreign 1body, 1otitis 1media, 1perforation, 1and 1otosclerosis 1of 1the 1involved 1side.
26. A 1young 1man 1is 1concerned 1about 1a 1hard 1mass 1he 1has 1just 1noticed 1in 1the 1midline 1of 1his
1palate. 1On 1examination, 1it 1is 1indeed 1hard 1and 1in 1the 1midline. 1There 1are 1no 1mucosal
1abnormalities 1associated 1with 1this 1lesion. 1He 1is 1experiencing 1no 1other 1symptoms. 1What 1will
1you 1tell 1him 1is 1the 1most 1likely 1diagnosis?
A) Leukoplakia
B) Torus 1palatinus
C) Thrush 1(candidiasis)
D) Kaposi's 1sarcoma
Ans: 1B
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Feedback: Torus palatinus is relatively common and benign but can go unnoticed by the patient
for many years. The appearance of a bony mass can be concerning. Leukoplakia is a white
lesion on the mucosal surfaces corresponding to chronic mechanical or chemical irritation. It can
be premalignant. Thrush is usually painful and is seen in immunosuppressed patients or those
taking 1inhaled 1steroids 1for 1COPD 1or 1asthma. 1Kaposi's 1sarcoma 1is 1usually 1seen 1in 1HIV-positive
1individuals 1and 1is 1classically 1a 1deep 1purple.
27. A 1young 1woman 1undergoes 1cranial 1nerve 1testing. 1On 1touching 1the 1soft 1palate, 1her
1uvula 1deviates 1to 1the 1left. 1 Which 1of 1the 1following 1is 1likely?
A) CN 1IX 1lesion 1on 1the 1left
B) CN 1IX 1lesion 1on 1the 1right
C) CN 1X 1lesion 1on 1the 1left
D) CN 1X 1lesion 1on 1the 1right
Ans: 1D
Feedback: 1The 1failure 1of 1the 1right 1side 1of 1the 1palate 1to 1rise 1denotes 1a 1problem 1with 1the 1right 110th
1cranial 1nerve. 1 The 1uvula 1deviates 1toward 1the 1properly 1functioning 1side.
28. A 1college 1student 1presents 1with 1a 1sore 1throat, 1fever, 1and 1fatigue 1for 1several 1days. 1 You
1notice 1exudates 1on 1her 1enlarged 1tonsils. 1You 1do 1a 1careful 1lymphatic 1examination 1and 1notice
1some 1scattered 1small, 1mobile 1lymph 1nodes 1just 1behind 1her 1sternocleidomastoid 1muscles
1bilaterally. 1What 1group 1of 1nodes 1is 1this?
A) Submandibular
B) Tonsillar
C) Occipital
D) Posterior 1cervical
Ans: 1D
Feedback: 1The 1group 1of 1nodes 1posterior 1to 1the 1sternocleidomastoid 1muscle 1is 1the 1posterior
1cervical 1chain. 1 These 1are 1common 1in 1mononucleosis.
29. You 1feel 1a 1small 1mass 1that 1you 1think 1is 1a 1lymph 1node. 1It 1is 1mobile 1in 1both 1the 1up-anddown 1and 1side-to-side 1directions. 1Which 1of 1the 1following 1is 1most 1likely?
A) Cancer
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B) Lymph node
C) Deep scar
D) Muscle
Ans: B
Feedback: 1A 1useful 1maneuver 1for 1discerning 1lymph 1nodes 1from 1other 1masses 1in 1the 1neck 1is 1to
1check 1for 1their 1mobility 1in 1all 1directions. 1Many 1other 1masses 1are 1mobile 1in 1only 1two
1directions. 1Cancerous 1masses 1may 1also 1be 1―fixed,‖ 1or 1immobile.
30. You 1are 1conducting 1a 1pupillary 1examination 1on 1a 134-year-old 1man. 1You 1note 1that 1both
1pupils 1dilate 1slightly. 1 Both 1are 1noted 1to 1constrict 1briskly 1when 1the 1light 1is 1placed 1on 1the
1right 1eye. 1 What 1is 1the 1most 1likely 1problem?
A) Optic 1nerve 1damage 1on 1the 1right
B) Optic 1nerve 1damage 1on 1the 1left
C) Efferent 1nerve 1damage 1on 1the 1right
D) Efferent 1nerve 1damage 1on 1the 1left
Ans: 1B
Feedback: 1Because 1both 1pupils 1can 1constrict, 1efferent 1nerve 1damage 1is 1unlikely. 1When 1the
1light 1is 1placed 1on 1the 1left 1eye, 1neither 1a 1direct 1nor 1a 1consensual 1response 1is 1seen. 1This
1indicates 1that 1the 1left 1eye 1is 1not 1perceiving 1incoming 1light.
Chapter 111 1The 1Eyes
1
MULTIPLE 1CHOICE
1. When 1examining 1the 1eye, 1the 1nurse 1notices 1that 1the 1patients 1eyelid 1margins
approximate 1completely. 1The 1nurse 1recognizes 1that 1this 1assessment 1finding:
1
a. Is 1expected.
b. May 1indicate 1a 1problem 1with 1extraocular 1muscles.
c. May 1result 1in 1problems 1with 1tearing.
d. Indicates 1increased 1intraocular 1pressure.
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ANS: A
The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid
margins approximate completely, which is a normal finding.
2. During 1ocular 1examinations, 1the 1nurse 1keeps 1in 1mind 1that 1movement 1of 1the
extraocular 1muscles 1is:
1
a. Decreased 1in 1the 1older 1adult.
b. Impaired 1in 1a 1patient 1with 1cataracts.
c. Stimulated 1by 1cranial 1nerves 1(CNs) 1I 1and 1II.
d. Stimulated 1by 1CNs 1III, 1IV, 1and 1VI.
ANS: 1D
Movement 1of 1the 1extraocular 1muscles 1is 1stimulated 1by 1three 1CNs: 1III, 1IV, 1and 1VI.
3. The 1nurse 1is 1performing 1an 1external 1eye 1examination. 1Which 1statement 1regarding 1the
outer 1layer 1of 1the 1eye 1is 1true?
1
a. The 1outer 1layer 1of 1the 1eye 1is 1very 1sensitive 1to 1touch.
b. The 1outer 1layer 1of 1the 1eye 1is 1darkly 1pigmented 1to 1prevent 1light 1from
1reflecting 1internally.
c. The 1trigeminal 1nerve 1(CN 1V) 1and 1the 1trochlear 1nerve 1(CN 1IV) 1are
1stimulated 1when 1the 1outer 1surface 1of 1the 1eye 1is 1stimulated.
d. The 1visual 1receptive 1layer 1of 1the 1eye 1in 1which 1light 1waves 1are 1changed 1into
1nerve 1impulses 1is 1located 1in 1the 1outer 1layer 1of 1the 1eye.
ANS: 1A
The 1cornea 1and 1the 1sclera 1make 1up 1the 1outer 1layer 1of 1the 1eye. 1The 1cornea 1is 1very 1sensitive 1to
1
touch. 1The 1middle 1layer, 1the 1choroid, 1has 1dark 1pigmentation 1to 1prevent 1light 1from 1reflecting
1
internally. 1The 1trigeminal 1nerve 1(CN 1V) 1and 1the 1facial 1nerve 1(CN 1VII) 1are 1stimulated 1when
the 1outer 1surface 1of 1the 1eye 1is 1stimulated. 1The 1retina, 1in 1the 1inner 1layer 1of 1the 1eye, 1is 1where
1
1
light 1waves 1are 1changed 1into 1nerve 1impulses.
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ANS: A
The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid
margins approximate completely, which is a normal finding.
b. Adjusts 1the 1eye 1for 1near 1vision.
c. Elevates 1the 1eyelid 1and 1dilates 1the 1pupil.
d. Causes 1contraction 1of 1the 1ciliary 1body.
ANS: 1C
Stimulation 1of 1the 1sympathetic 1branch 1of 1the 1autonomic 1nervous 1system 1dilates 1the 1pupil
1
and 1elevates 1the 1eyelid. 1Parasympathetic 1nervous 1system 1stimulation 1causes 1the 1pupil 1to
1
constrict. 1The 1muscle 1fibers 1of 1the 1iris 1contract 1the 1pupil 1in 1bright 1light 1to 1accommodate 1for
near 1vision. 1The 1ciliary 1body 1controls 1the 1thickness 1of 1the 1lens.
1
5. The 1nurse 1is 1reviewing 1causes 1of 1increased 1intraocular 1pressure. 1Which 1of 1these
factors 1determines 1intraocular 1pressure?
1
a. Thickness 1or 1bulging 1of 1the 1lens
b. Posterior 1chamber 1as 1it 1accommodates 1increased 1fluid
c. Contraction 1of 1the 1ciliary 1body 1in 1response 1to 1the 1aqueous 1within 1the 1eye
d. Amount 1of 1aqueous 1produced 1and 1resistance 1to 1its 1outflow 1at 1the 1angle 1of
1the 1anterior 1chamber
ANS: 1D
Intraocular 1pressure 1is 1determined 1by 1a 1balance 1between 1the 1amount 1of 1aqueous 1produced 1and 1the
1
resistance 1to 1its 1outflow 1at 1the 1angle 1of 1the 1anterior 1chamber. 1The 1other 1responses 1are 1incorrect.
6. The 1nurse 1is 1conducting 1a 1visual 1examination. 1Which 1of 1these 1statements 1regarding
visual 1pathways 1and 1visual 1fields 1is 1true?
1
a. The 1right 1side 1of 1the 1brain 1interprets 1the 1vision 1for 1the 1right 1eye.
b. The 1image 1formed 1on 1the 1retina 1is 1upside 1down 1and 1reversed 1from 1its
1actual 1appearance 1in 1the 1outside 1world.
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c. Light rays are refracted through the transparent media of the eye before striking
the pupil.
d. Light impulses are conducted through the optic nerve to the temporal lobes of the
brain.
ANS: 1B
The 1image 1formed 1on 1the 1retina 1is 1upside 1down 1and 1reversed 1from 1its 1actual 1appearance 1in
1
the 1outside 1world. 1The 1light 1rays 1are 1refracted 1through 1the 1transparent 1media 1of 1the 1eye
1
before 1striking 1the 1retina, 1and 1the 1nerve 1impulses 1are 1conducted 1through 1the 1optic 1nerve 1tract
1
to 1the 1visual 1cortex 1of 1the 1occipital 1lobe 1of 1the 1brain. 1The 1left 1side 1of 1the 1brain 1interprets
vision 1for 1the 1right 1eye.
1
7. The 1nurse 1is 1testing 1a 1patients 1visual 1accommodation, 1which 1refers 1to 1which 1action?
a. Pupillary 1constriction 1when 1looking 1at 1a 1near 1object
b. Pupillary 1dilation 1when 1looking 1at 1a 1far 1object
c. Changes 1in 1peripheral 1vision 1in 1response 1to 1light
d. Involuntary 1blinking 1in 1the 1presence 1of 1bright 1light
ANS: 1A
The 1muscle 1fibers 1of 1the 1iris 1contract 1the 1pupil 1in 1bright 1light 1and 1accommodate 1for 1near
vision, 1which 1also 1results 1in 1pupil 1constriction. 1The 1other 1responses 1are 1not 1correct.
1
8. A 1patient 1has 1a 1normal 1pupillary 1light 1reflex. 1The 1nurse 1recognizes 1that 1this 1reflex
1
indicates 1that:
a. The 1eyes 1converge 1to 1focus 1on 1the 1light.
b. Light 1is 1reflected 1at 1the 1same 1spot 1in 1both 1eyes.
c. The 1eye 1focuses 1the 1image 1in 1the 1center 1of 1the 1pupil.
d. Constriction 1of 1both 1pupils 1occurs 1in 1response 1to 1bright 1light.
ANS: 1D
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The pupillary light reflex is the normal constriction of the pupils when bright light shines on the
retina. The other responses are not correct.
9. A mother asks when her newborn infants eyesight will be developed. The nurse should reply:
a. Vision 1is 1not 1totally 1developed 1until 12 1years 1of 1age.
b. Infants 1develop 1the 1ability 1to 1focus 1on 1an 1object 1at 1approximately 18 1months
1of 1age.
c. By 1approximately 13 1months 1of 1age, 1infants 1develop 1more 1coordinated
1eye 1movements 1and 1can 1fixate 1on 1an 1object.
d. Most 1infants 1have 1uncoordinated 1eye 1movements 1for 1the 1first 1year 1of 1life.
ANS: 1C
Eye 1movements 1may 1be 1poorly 1coordinated 1at 1birth, 1but 1by 13 1to 14 1months 1of 1age, 1the 1infant
1
should 1establish 1binocularity 1and 1should 1be 1able 1to 1fixate 1simultaneously 1on 1a 1single 1image
with 1both 1eyes.
1
10. The 1nurse 1is 1reviewing 1in 1age-related 1changes 1in 1the 1eye 1for 1a 1class. 1Which 1of
these 1physiologic 1changes 1is 1responsible 1for 1presbyopia?
1
a. Degeneration 1of 1the 1cornea
b. Loss 1of 1lens 1elasticity
c. Decreased 1adaptation 1to 1darkness
d. Decreased 1distance 1vision 1abilities
ANS: 1B
The 1lens 1loses 1elasticity 1and 1decreases 1its 1ability 1to 1change 1shape 1to 1accommodate 1for 1near
1
vision. 1This 1condition 1is 1called 1presbyopia.
11. Which 1of 1these 1assessment 1findings 1would 1the 1nurse 1expect 1to 1see 1when 1examining 1the
eyes 1of 1a 1black 1patient?
1
a. Increased 1night 1vision
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b. Dark retinal background
c. Increased photosensitivity
d. Narrowed palpebral fissures
ANS: 1B
An 1ethnically 1based 1variability 1in 1the 1color 1of 1the 1iris 1and 1in 1retinal 1pigmentation 1exists, 1with
1
darker 1irides 1having 1darker 1retinas 1behind 1them.
12. A 152-year-old 1patient 1describes 1the 1presence 1of 1occasional 1floaters 1or 1spots 1moving 1in
front 1of 1his 1eyes. 1The 1nurse 1should:
1
a. Examine 1the 1retina 1to 1determine 1the 1number 1of 1floaters.
b. Presume 1the 1patient 1has 1glaucoma 1and 1refer 1him 1for 1further 1testing.
c. Consider 1these 1to 1be 1abnormal 1findings, 1and 1refer 1him 1to 1an 1ophthalmologist.
d. Know 1that 1floaters 1are 1usually 1insignificant 1and 1are 1caused 1by 1condensed
1vitreous 1fibers.
ANS: 1D
Floaters 1are 1a 1common 1sensation 1with 1myopia 1or 1after 1middle 1age 1and 1are 1attributable 1to
1
condensed 1vitreous 1fibers. 1Floaters 1or 1spots 1are 1not 1usually 1significant, 1but 1the 1acute 1onset 1of
1
floaters 1may 1occur 1with 1retinal 1detachment.
13. The 1nurse 1is 1preparing 1to 1assess 1the 1visual 1acuity 1of 1a 116-year-old 1patient. 1How 1should
the 1nurse 1proceed?
1
a. Perform 1the 1confrontation 1test.
b. Ask 1the 1patient 1to 1read 1the 1print 1on 1a 1handheld 1Jaeger 1card.
c. Use 1the 1Snellen 1chart 1positioned 120 1feet 1away 1from 1the 1patient.
d. Determine 1the 1patients 1ability 1to 1read 1newsprint 1at 1a 1distance 1of 112 1to 114 1inches.
ANS: 1C
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The Snellen alphabet chart is the most commonly used and most accurate measure of visual
acuity. The confrontation test is a gross measure of peripheral vision. The Jaeger card or
newspaper tests are used to test near vision.
14. A 1patients 1vision 1is 1recorded 1as 120/30 1when 1the 1Snellen 1eye 1chart 1is 1used. 1The
nurse 1interprets 1these 1results 1to 1indicate 1that:
1
a. At 130 1feet 1the 1patient 1can 1read 1the 1entire 1chart.
b. The 1patient 1can 1read 1at 120 1feet 1what 1a 1person 1with 1normal 1vision 1can 1read 1at
130 1feet.
c. The 1patient 1can 1read 1the 1chart 1from 120 1feet 1in 1the 1left 1eye 1and 130 1feet 1in 1the
1right 1eye.
d. The 1patient 1can 1read 1from 130 1feet 1what 1a 1person 1with 1normal 1vision 1can 1read
1from 120 1feet.
ANS: 1B
The 1top 1number 1indicates 1the 1distance 1the 1person 1is 1standing 1from 1the 1chart; 1the 1denominator
1
gives 1the 1distance 1at 1which 1a 1normal 1eye 1can 1see.
15. A 1patient 1is 1unable 1to 1read 1even 1the 1largest 1letters 1on 1the 1Snellen 1chart. 1The 1nurse 1should
take 1which 1action 1next?
1
a. Refer 1the 1patient 1to 1an 1ophthalmologist 1or 1optometrist 1for 1further 1evaluation.
b. Assess 1whether 1the 1patient 1can 1count 1the 1nurses 1fingers 1when 1they 1are 1placed
1in 1front 1of 1his 1or 1her 1eyes.
c. Ask 1the 1patient 1to 1put 1on 1his 1or 1her 1reading 1glasses 1and 1attempt 1to 1read 1the
1Snellen 1chart 1again.
d. Shorten 1the 1distance 1between 1the 1patient 1and 1the 1chart 1until 1the 1letters 1are
1seen, 1and 1record 1that 1distance.
ANS: 1D
If 1the 1person 1is 1unable 1to 1see 1even 1the 1largest 1letters 1when 1standing 120 1feet 1from 1the 1chart, 1then
1
the 1nurse 1should 1shorten 1the 1distance 1to 1the 1chart 1until 1the 1letters 1are 1seen, 1and 1record 1that
1
distance 1(e.g., 110/200). 1If 1visual 1acuity 1is 1even 1lower, 1then 1the 1nurse 1should 1assess 1whether
the
1
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person can count fingers when they are spread in front of the eyes or can distinguish light
perception from a penlight. If vision is poorer than 20/30, then a referral to an ophthalmologist or
optometrist is necessary, but the nurse must first assess the visual acuity.
16. A 1patients 1vision 1is 1recorded 1as 120/80 1in 1each 1eye. 1The 1nurse 1interprets 1this 1finding 1to
mean 1that 1the 1patient:
1
a. Has 1poor 1vision.
b. Has 1acute 1vision.
c. Has 1normal 1vision.
d. Is 1presbyopic.
ANS: 1A
Normal 1visual 1acuity 1is 120/20 1in 1each 1eye; 1the 1larger 1the 1denominator, 1the 1poorer 1the 1vision.
17. When 1performing 1the 1corneal 1light 1reflex 1assessment, 1the 1nurse 1notes 1that 1the 1light
is 1reflected 1at 12 1oclock 1in 1each 1eye. 1The 1nurse 1should:
1
a. Consider 1this 1a 1normal 1finding.
b. Refer 1the 1individual 1for 1further 1evaluation.
c. Document 1this 1finding 1as 1an 1asymmetric 1light 1reflex.
d. Perform 1the 1confrontation 1test 1to 1validate 1the 1findings.
ANS: 1A
Reflection 1of 1the 1light 1on 1the 1corneas 1should 1be 1in 1exactly 1the 1same 1spot 1on 1each 1eye, 1or
1
symmetric. 1If 1asymmetry 1is 1noted, 1then 1the 1nurse 1should 1administer 1the 1cover 1test.
18. The 1nurse 1is 1performing 1the 1diagnostic 1positions 1test. 1Normal 1findings 1would 1be 1which
of 1these 1results?
1
a. Convergence 1of 1the 1eyes
b. Parallel 1movement 1of 1both 1eyes
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
c. Nystagmus in extreme superior gaze
d. Slight amount of lid lag when moving the eyes from a superior to an inferior
position
ANS: 1B
A 1normal 1response 1for 1the 1diagnostic 1positions 1test 1is 1parallel 1tracking 1of 1the 1object 1with 1both
1
eyes. 1Eye 1movement 1that 1is 1not 1parallel 1indicates 1a 1weakness 1of 1an 1extraocular 1muscle 1or
1
dysfunction 1of 1the 1CN 1that 1innervates 1it.
19. During 1an 1assessment 1of 1the 1sclera 1of 1a 1black 1patient, 1the 1nurse 1would 1consider 1which
of 1these 1an 1expected 1finding?
1
a. Yellow 1fatty 1deposits 1over 1the 1cornea
b. Pallor 1near 1the 1outer 1canthus 1of 1the 1lower 1lid
c. Yellow 1color 1of 1the 1sclera 1that 1extends 1up 1to 1the 1iris
d. Presence 1of 1small 1brown 1macules 1on 1the 1sclera
ANS: 1D
Normally 1in 1dark-skinned 1people, 1small 1brown 1macules 1may 1be 1observed 1in 1the 1sclera.
20. A 160-year-old 1man 1is 1at 1the 1clinic 1for 1an 1eye 1examination. 1The 1nurse 1suspects 1that 1he
has 1ptosis 1of 1one 1eye. 1How 1should 1the 1nurse 1check 1for 1this?
1
a. Perform 1the 1confrontation 1test.
b. Assess 1the 1individuals 1near 1vision.
c. Observe 1the 1distance 1between 1the 1palpebral 1fissures.
d. Perform 1the 1corneal 1light 1test, 1and 1look 1for 1symmetry 1of 1the 1light 1reflex.
ANS: 1C
Ptosis 1is 1a 1drooping 1of 1the 1upper 1eyelid 1that 1would 1be 1apparent 1by 1observing 1the
1
distance 1between 1the 1upper 1and 1lower 1eyelids. 1The 1confrontation 1test 1measures
1
peripheral 1vision. 1Measuring 1near 1vision 1or 1the 1corneal 1light 1test 1does 1not 1check 1for
1
ptosis.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
21. During an examination of the eye, the nurse would expect what normal finding when
assessing the lacrimal apparatus?
a. Presence of tears along the inner canthus
b. Blocked 1nasolacrimal 1duct 1in 1a 1newborn 1infant
c. Slight 1swelling 1over 1the 1upper 1lid 1and 1along 1the 1bony 1orbit 1if 1the 1individual 1has
1a 1cold
d. Absence 1of 1drainage 1from 1the 1puncta 1when 1pressing 1against 1the 1inner 1orbital 1rim
ANS: 1D
No 1swelling, 1redness, 1or 1drainage 1from 1the 1puncta 1should 1be 1observed 1when 1it 1is 1pressed.
1
Regurgitation 1of 1fluid 1from 1the 1puncta, 1when 1pressed, 1indicates 1duct 1blockage. 1The 1lacrimal
1
glands 1are 1not 1functional 1at 1birth.
22. When 1assessing 1the 1pupillary 1light 1reflex, 1the 1nurse 1should 1use 1which 1technique?
a. Shine 1a 1penlight 1from 1directly 1in 1front 1of 1the 1patient, 1and 1inspect 1for
1pupillary 1constriction.
b. Ask 1the 1patient 1to 1follow 1the 1penlight 1in 1eight 1directions, 1and 1observe 1for
1bilateral 1pupil 1constriction.
c. Shine 1a 1light 1across 1the 1pupil 1from 1the 1side, 1and 1observe 1for 1direct 1and
1consensual 1pupillary 1constriction.
d. Ask 1the 1patient 1to 1focus 1on 1a 1distant 1object. 1Then 1ask 1the 1patient 1to 1follow
1the 1penlight 1to 1approximately 17 1cm 1from 1the 1nose.
ANS: 1C
To 1test 1the 1pupillary 1light 1reflex, 1the 1nurse 1should 1advance 1a 1light 1in 1from 1the 1side 1and 1note
the 1direct 1and 1consensual 1pupillary 1constriction.
1
23. The 1nurse 1is 1assessing 1a 1patients 1eyes 1for 1the 1accommodation 1response 1and 1would 1expect
to 1see 1which 1normal 1finding?
1
a. Dilation 1of 1the 1pupils
b. Consensual 1light 1reflex
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c. Conjugate movement of the eyes
d. Convergence of the axes of the eyes
ANS: 1D
The 1accommodation 1reaction 1includes 1pupillary 1constriction 1and 1convergence 1of 1the 1axes 1of
1
the 1eyes. 1The 1other 1responses 1are 1not 1correct.
24. In 1using 1the 1ophthalmoscope 1to 1assess 1a 1patients 1eyes, 1the 1nurse 1notices 1a 1red 1glow 1in
the 1patients 1pupils. 1On 1the 1basis 1of 1this 1finding, 1the 1nurse 1would:
1
a. Suspect 1that 1an 1opacity 1is 1present 1in 1the 1lens 1or 1cornea.
b. Check 1the 1light 1source 1of 1the 1ophthalmoscope 1to 1verify 1that 1it 1is 1functioning.
c. Consider 1the 1red 1glow 1a 1normal 1reflection 1of 1the 1ophthalmoscope 1light 1off
1the 1inner 1retina.
d. Continue 1with 1the 1ophthalmoscopic 1examination, 1and 1refer 1the 1patient 1for
1further 1evaluation.
ANS: 1C
The 1red 1glow 1filling 1the 1persons 1pupil 1is 1the 1red 1reflex 1and 1is 1a 1normal 1finding 1caused 1by 1the
1
reflection 1of 1the 1ophthalmoscope 1light 1off 1the 1inner 1retina. 1The 1other 1responses 1are 1not 1correct.
25. The 1nurse 1is 1examining 1a 1patients 1retina 1with 1an 1ophthalmoscope. 1Which 1finding
is 1considered 1normal?
1
a. Optic 1disc 1that 1is 1a 1yellow-orange 1color
b. Optic 1disc 1margins 1that 1are 1blurred 1around 1the 1edges
c. Presence 1of 1pigmented 1crescents 1in 1the 1macular 1area
d. Presence 1of 1the 1macula 1located 1on 1the 1nasal 1side 1of 1the 1retina
ANS: 1A
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
The optic disc is located on the nasal side of the retina. Its color is a creamy yellow-orange to a
pink, and the edges are distinct and sharply demarcated, not blurred. A pigmented crescent is
black and is due to the accumulation of pigment in the choroid.
Chapter 112 1Ears, 1Nose, 1Mouth, 1and 1Throat
1
MULTIPLE 1CHOICE
1. The 1primary 1purpose 1of 1the 1ciliated 1mucous 1membrane 1in 1the 1nose 1is 1to:
a. Warm 1the 1inhaled 1air.
b. Filter 1out 1dust 1and 1bacteria.
c. Filter 1coarse 1particles 1from 1inhaled 1air.
d. Facilitate 1the 1movement 1of 1air 1through 1the 1nares.
ANS: 1B
The 1nasal 1hairs 1filter 1the 1coarsest 1matter 1from 1inhaled 1air, 1whereas 1the 1mucous 1blanket 1filters
out 1dust 1and 1bacteria. 1The 1rich 1blood 1supply 1of 1the 1nasal 1mucosa 1warms 1the 1inhaled 1air.
1
2. The 1projections 1in 1the 1nasal 1cavity 1that 1increase 1the 1surface 1area 1are 1called 1the:
a. Meatus.
b. Septum.
c. Turbinates.
d. Kiesselbach 1plexus.
ANS: 1C
The 1lateral 1walls 1of 1each 1nasal 1cavity 1contain 1three 1parallel 1bony 1projections: 1the 1superior,
1
middle, 1and 1inferior 1turbinates. 1These 1increase 1the 1surface 1area, 1making 1more 1blood 1vessels
and 1mucous 1membrane 1available 1to 1warm, 1humidify, 1and 1filter 1the 1inhaled 1air.
1
3. The 1nurse 1is 1reviewing 1the 1development 1of 1the 1newborn 1infant. 1Regarding 1the 1sinuses,
which 1statement 1is 1true 1in 1relation 1to 1a 1newborn 1infant?
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
a. Sphenoid sinuses are full size at birth.
b. Maxillary sinuses reach full size after puberty.
c. Frontal sinuses are fairly well developed at birth.
d. 1 Maxillary 1and 1ethmoid 1sinuses 1are 1the 1only 1sinuses 1present 1at 1birth.
ANS: 1D
Only 1the 1maxillary 1and 1ethmoid 1sinuses 1are 1present 1at 1birth. 1The 1sphenoid 1sinuses 1are 1minute
1
at 1birth 1and 1develop 1after 1puberty. 1The 1frontal 1sinuses 1are 1absent 1at 1birth, 1are 1fairly 1well
developed 1at 1age 17 1to 18 1years, 1and 1reach 1full 1size 1after 1puberty.
1
4. The 1tissue 1that 1connects 1the 1tongue 1to 1the 1floor 1of 1the 1mouth 1is 1the:
a. Uvula.
b. Palate.
c. Papillae.
d. Frenulum.
ANS: 1D
The 1frenulum 1is 1a 1midline 1fold 1of 1tissue 1that 1connects 1the 1tongue 1to 1the 1floor 1of 1the 1mouth.
The 1uvula 1is 1the 1free 1projection 1hanging 1down 1from 1the 1middle 1of 1the 1soft 1palate. 1The 1palate
1
1
is 1the 1arching 1roof 1of 1the 1mouth. 1Papillae 1are 1the 1rough, 1bumpy 1elevations 1on 1the 1tongues
1
dorsal 1surface.
5. The 1salivary 1gland 1that 1is 1the 1largest 1and 1located 1in 1the 1cheek 1in 1front 1of 1the 1ear 1is 1the
gland.
a. Parotid
b. Stensens
c. Sublingual
d. Submandibular
ANS: 1A
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The mouth contains three pairs of salivary glands. The largest, the parotid gland, lies within the
cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. The
Stensens duct (not gland) drains the parotid gland onto the buccal mucosa opposite the second
molar. 1The 1sublingual 1gland 1is 1located 1within 1the 1floor 1of 1the 1mouth 1under 1the 1tongue. 1The
1
submandibular 1gland 1lies 1beneath 1the 1mandible 1at 1the 1angle 1of 1the 1jaw.
6. In 1assessing 1the 1tonsils 1of 1a 130 1year 1old, 1the 1nurse 1notices 1that 1they 1are 1involuted, 1granular
in 1appearance, 1and 1appear 1to 1have 1deep 1crypts. 1What 1is 1correct 1response 1to 1these 1findings?
1
a. Refer 1the 1patient 1to 1a 1throat 1specialist.
b. No 1response 1is 1needed; 1this 1appearance 1is 1normal 1for 1the 1tonsils.
c. Continue 1with 1the 1assessment, 1looking 1for 1any 1other 1abnormal 1findings.
d. Obtain 1a 1throat 1culture 1on 1the 1patient 1for 1possible 1streptococcal 1(strep) 1infection.
ANS: 1B
The 1tonsils 1are 1the 1same 1color 1as 1the 1surrounding 1mucous 1membrane, 1although 1they 1look 1more
1
granular 1and 1their 1surface 1shows 1deep 1crypts. 1Tonsillar 1tissue 1enlarges 1during 1childhood 1until
1
puberty 1and 1then 1involutes.
7. The 1nurse 1is 1obtaining 1a 1health 1history 1on 1a 13-month-old 1infant. 1During 1the 1interview,
1
the 1mother 1states, 1I 1think 1she 1is 1getting 1her 1first 1tooth 1because 1she 1has 1started 1drooling 1a
lot. 1The 1nurses 1best 1response 1would 1be:
1
a. Youre 1right, 1drooling 1is 1usually 1a 1sign 1of 1the 1first 1tooth.
b. It 1would 1be 1unusual 1for 1a 13 1month 1old 1to 1be 1getting 1her 1first 1tooth.
c. This 1could 1be 1the 1sign 1of 1a 1problem 1with 1the 1salivary 1glands.
d. She 1is 1just 1starting 1to 1salivate 1and 1hasnt 1learned 1to 1swallow 1the 1saliva.
ANS: 1D
In 1the 1infant, 1salivation 1starts 1at 13 1months. 1The 1baby 1will 1drool 1for 1a 1few 1months 1before
1
learning 1to 1swallow 1the 1saliva. 1This 1drooling 1does 1not 1herald 1the 1eruption 1of 1the 1first 1tooth,
although 1many 1parents 1think 1it 1does.
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
8. The nurse is assessing an 80-year-old patient. Which of these findings would be expected for
this patient?
a. Hypertrophy of the gums
b. Increased 1production 1of 1saliva
c. Decreased 1ability 1to 1identify 1odors
d. Finer 1and 1less 1prominent 1nasal 1hair
ANS: 1C
The 1sense 1of 1smell 1may 1be 1reduced 1because 1of 1a 1decrease 1in 1the 1number 1of 1olfactory 1nerve
fibers. 1Nasal 1hairs 1grow 1coarser 1and 1stiffer 1with 1aging. 1The 1gums 1may 1recede 1with 1aging, 1not
1
1
hypertrophy, 1and 1saliva 1production 1decreases.
9. The 1nurse 1is 1performing 1an 1oral 1assessment 1on 1a 140-year-old 1Black 1patient 1and 1notices
1
the 1presence 1of 1a 11 1cm, 1nontender, 1grayish-white 1lesion 1on 1the 1left 1buccal 1mucosa. 1Which
one 1of 1these 1statements 1is 1true? 1This 1lesion 1is:
1
a. Leukoedema 1and 1is 1common 1in 1dark-pigmented 1persons.
b. The 1result 1of 1hyperpigmentation 1and 1is 1normal.
c. Torus 1palatinus 1and 1would 1normally 1be 1found 1only 1in 1smokers.
d. Indicative 1of 1cancer 1and 1should 1be 1immediately 1tested.
ANS: 1A
Leukoedema, 1a 1grayish-white 1benign 1lesion 1occurring 1on 1the 1buccal 1mucosa, 1is 1most 1often
1
observed 1in 1Blacks.
10. While 1obtaining 1a 1health 1history, 1a 1patient 1tells 1the 1nurse 1that 1he 1has 1frequent 1nosebleeds
and 1asks 1the 1best 1way 1to 1get 1them 1to 1stop. 1What 1would 1be 1the 1nurses 1best 1response?
1
a. While 1sitting 1up, 1place 1a 1cold 1compress 1over 1your 1nose.
b. Sit 1up 1with 1your 1head 1tilted 1forward 1and 1pinch 1your 1nose.
c. Just 1allow 1the 1bleeding 1to 1stop 1on 1its 1own, 1but 1dont 1blow 1your 1nose.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
d. Lie on your back with your head tilted back and pinch your nose.
ANS: B
With 1a 1nosebleed, 1the 1person 1should 1sit 1up 1with 1the 1head 1tilted 1forward 1and 1pinch 1the 1nose
1
between 1the 1thumb 1and 1forefinger 1for 15 1to 115 1minutes.
11. A 192-year-old 1patient 1has 1had 1a 1stroke. 1The 1right 1side 1of 1his 1face 1is 1drooping. 1The
nurse 1might 1also 1suspect 1which 1of 1these 1assessment 1findings?
1
a. Epistaxis
b. Rhinorrhea
c. Dysphagia
d. Xerostomia
ANS: 1C
Dysphagia 1is 1difficulty 1with 1swallowing 1and 1may 1occur 1with 1a 1variety 1of 1disorders, 1including
1
stroke 1and 1other 1neurologic 1diseases. 1Rhinorrhea 1is 1a 1runny 1nose, 1epistaxis 1is 1a 1bloody 1nose,
1
and 1xerostomia 1is 1a 1dry 1mouth.
12. While 1obtaining 1a 1health 1history 1from 1the 1mother 1of 1a 11-year-old 1child, 1the 1nurse 1notices
that 1the 1baby 1has 1had 1a 1bottle 1in 1his 1mouth 1the 1entire 1time. 1The 1mother 1states, 1It 1makes 1a
1
1
great 1pacifier. 1The 1best 1response 1by 1the 1nurse 1would 1be:
a. Youre 1right. 1Bottles 1make 1very 1good 1pacifiers.
b. Using 1a 1bottle 1as 1a 1pacifier 1is 1better 1for 1the 1teeth 1than 1thumb-sucking.
c. Its 1okay 1to 1use 1a 1bottle 1as 1long 1as 1it 1contains 1milk 1and 1not 1juice.
d. Prolonged 1use 1of 1a 1bottle 1can 1increase 1the 1risk 1for 1tooth 1decay 1and 1ear 1infections.
ANS: 1D
Prolonged 1bottle 1use 1during 1the 1day 1or 1when 1going 1to 1sleep 1places 1the 1infant 1at 1risk 1for 1tooth
1
decay 1and 1middle 1ear 1infections.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
13. A 72-year-old patient has a history of hypertension and chronic lung disease. An important
question for the nurse to include in the health history would be:
a. Do you use a fluoride supplement?
b. Have 1you 1had 1tonsillitis 1in 1the 1last 1year?
c. At 1what 1age 1did 1you 1get 1your 1first 1tooth?
d. Have 1you 1noticed 1any 1dryness 1in 1your 1mouth?
ANS: 1D
Xerostomia 1(dry 1mouth) 1is 1a 1side 1effect 1of 1many 1drugs 1taken 1by 1older 1people, 1including
1
antidepressants, 1anticholinergics, 1antispasmodics, 1antihypertensives, 1antipsychotics, 1and
1
bronchodilators.
14. The 1nurse 1is 1using 1an 1otoscope 1to 1assess 1the 1nasal 1cavity. 1Which 1of 1these 1techniques 1is
correct?
a. Inserting 1the 1speculum 1at 1least 13 1cm 1into 1the 1vestibule
b. Avoiding 1touching 1the 1nasal 1septum 1with 1the 1speculum
c. Gently 1displacing 1the 1nose 1to 1the 1side 1that 1is 1being 1examined
d. Keeping 1the 1speculum 1tip 1medial 1to 1avoid 1touching 1the 1floor 1of 1the 1nares
ANS: 1B
The 1correct 1technique 1for 1using 1an 1otoscope 1is 1to 1insert 1the 1apparatus 1into 1the 1nasal
1
vestibule, 1avoiding 1pressure 1on 1the 1sensitive 1nasal 1septum. 1The 1tip 1of 1the 1nose 1should 1be
lifted 1up 1before 1inserting 1the 1speculum.
1
15. The 1nurse 1is 1performing 1an 1assessment 1on 1a 121-year-old 1patient 1and 1notices 1that 1his 1nasal
1
mucosa 1appears 1pale, 1gray, 1and 1swollen. 1What 1would 1be 1the 1most 1appropriate 1question 1to 1ask
the 1patient?
1
a. Are 1you 1aware 1of 1having 1any 1allergies?
b. Do 1you 1have 1an 1elevated 1temperature?
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c. Have you had any symptoms of a cold?
d. Have you been having frequent nosebleeds?
ANS: 1A
With 1chronic 1allergies, 1the 1mucosa 1looks 1swollen, 1boggy, 1pale, 1and 1gray. 1Elevated 1body
1
temperature, 1colds, 1and 1nosebleeds 1do 1not 1cause 1these 1mucosal 1changes.
16. The 1nurse 1needs 1to 1pull 1the 1portion 1of 1the 1ear 1that 1consists 1of 1movable 1cartilage 1and
skin 1down 1and 1back 1when 1administering 1eardrops. 1This 1portion 1of 1the 1ear 1is 1called 1the:
1
a. Auricle.
b. Concha.
c. Outer 1meatus.
d. Mastoid 1process.
ANS: 1A
The 1external 1ear 1is 1called 1the 1auricle 1or 1pinna 1and 1consists 1of 1movable 1cartilage 1and 1skin.
17. The 1nurse 1is 1examining 1a 1patients 1ears 1and 1notices 1cerumen 1in 1the 1external 1canal. 1Which
of 1these 1statements 1about 1cerumen 1is 1correct?
1
a. Sticky 1honey-colored 1cerumen 1is 1a 1sign 1of 1infection.
b. The 1presence 1of 1cerumen 1is 1indicative 1of 1poor 1hygiene.
c. The 1purpose 1of 1cerumen 1is 1to 1protect 1and 1lubricate 1the 1ear.
d. Cerumen 1is 1necessary 1for 1transmitting 1sound 1through 1the 1auditory 1canal.
ANS: 1C
The 1ear 1is 1lined 1with 1glands 1that 1secrete 1cerumen, 1which 1is 1a 1yellow 1waxy 1material 1that 1lubricates
1
and 1protects 1the 1ear.
18. When 1examining 1the 1ear 1with 1an 1otoscope, 1the 1nurse 1notes 1that 1the 1tympanic
membrane 1should 1appear:
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
a. Light pink with a slight bulge.
b. Pearly gray and slightly concave.
c. Pulled in at the base of the cone of light.
d. 1 Whitish 1with 1a 1small 1fleck 1of 1light 1in 1the 1superior 1portion.
ANS: 1B
The 1tympanic 1membrane 1is 1a 1translucent 1membrane 1with 1a 1pearly 1gray 1color 1and 1a 1prominent
1
cone 1of 1light 1in 1the 1anteroinferior 1quadrant, 1which 1is 1the 1reflection 1of 1the 1otoscope 1light. 1The
1
tympanic 1membrane 1is 1oval 1and 1slightly 1concave, 1pulled 1in 1at 1its 1center 1by 1the 1malleus, 1which
is 1one 1of 1the 1middle 1ear 1ossicles.
1
19. The 1nurse 1is 1reviewing 1the 1structures 1of 1the 1ear. 1Which 1of 1these 1statements 1concerning
the 1eustachian 1tube 1is 1true?
1
a. The 1eustachian 1tube 1is 1responsible 1for 1the 1production 1of 1cerumen.
b. It 1remains 1open 1except 1when 1swallowing 1or 1yawning.
c. The 1eustachian 1tube 1allows 1passage 1of 1air 1between 1the 1middle 1and 1outer 1ear.
d. It 1helps 1equalize 1air 1pressure 1on 1both 1sides 1of 1the 1tympanic 1membrane.
ANS: 1D
The 1eustachian 1tube 1allows 1an 1equalization 1of 1air 1pressure 1on 1each 1side 1of 1the 1tympanic
1
membrane 1so 1that 1the 1membrane 1does 1not 1rupture 1during, 1for 1example, 1altitude 1changes 1in 1an
1
airplane. 1The 1tube 1is 1normally 1closed, 1but 1it 1opens 1with 1swallowing 1or 1yawning.
20. A 1patient 1with 1a 1middle 1ear 1infection 1asks 1the 1nurse, 1What 1does 1the 1middle 1ear 1do? 1The
nurse 1responds 1by 1telling 1the 1patient 1that 1the 1middle 1ear 1functions 1to:
1
a.
Maintain 1balance.
b.
Interpret 1sounds 1as 1they 1enter 1the 1ear.
c.
Conduct 1vibrations 1of 1sounds 1to 1the 1inner 1ear.
d.
Increase 1amplitude 1of 1sound 1for 1the 1inner 1ear
1to 1function.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
ANS: C
Among its other functions, the middle ear conducts sound vibrations from the outer ear to the
central hearing apparatus in the inner ear. The other responses are not functions of the middle
ear.
21. The 1nurse 1is 1reviewing 1the 1function 1of 1the 1cranial 1nerves 1(CNs). 1Which 1CN 1is 1responsible
for 1conducting 1nerve 1impulses 1to 1the 1brain 1from 1the 1organ 1of 1Corti?
1
a. I
b. III
c. VIII
d. XI
ANS: 1C
The 1nerve 1impulses 1are 1conducted 1by 1the 1auditory 1portion 1of 1CN 1VIII 1to 1the 1brain.
Chapter 113 1The 1Respiratory 1System
1
Multiple 1Choice
1. A 121-year-old 1college 1senior 1presents 1to 1your 1clinic, 1complaining 1of 1shortness 1of 1breath 1and
1a 1nonproductive 1nocturnal 1cough. 1She 1states 1she 1used 1to 1feel 1this 1way 1only 1with 1extreme
1exercise, 1but 1lately 1she 1has 1felt 1this 1way 1continuously. 1She 1denies 1any 1other 1upper 1respiratory
1symptoms, 1chest 1pain, 1gastrointestinal 1symptoms, 1or 1urinary 1tract 1symptoms. 1Her 1past
1medical 1history 1is 1significant 1only 1for 1seasonal 1allergies, 1for 1which 1she 1takes 1a 1nasal 1steroid
1spray 1but 1is 1otherwise 1on 1no 1other 1medications. 1She 1has 1had 1no 1surgeries. 1Her 1mother 1has
1allergies 1and 1eczema 1and 1her 1father 1has 1high 1blood 1pressure. 1She 1is 1an 1only 1child. 1She 1denies
1smoking 1and 1illegal 1drug 1use 1but 1drinks 1three 1to 1four 1alcoholic 1beverages 1per 1weekend. 1She 1is
1a 1junior 1in 1finance 1at 1a 1local 1university 1and 1she 1has 1recently 1started 1a 1job 1as 1a 1bartender 1in
1town. 1On 1examination 1she 1is 1in 1no 1acute 1distress 1and 1her 1temperature 1is 198.6. 1Her 1blood
1pressure 1is 1120/80, 1her 1pulse 1is 180, 1and 1her 1respirations 1are 120. 1Her 1head, 1eyes, 1ears, 1nose,
1and 1throat 1examinations 1are 1essentially 1normal. 1Inspection 1of 1her 1anterior 1and 1posterior 1chest
1shows 1no 1abnormalities. 1On 1auscultation 1of 1her 1chest, 1there 1is 1decreased 1air 1movement 1and 1a
1high-pitched 1whistling 1on 1expiration 1in 1all 1lobes. 1Percussion 1reveals 1resonant 1lungs.
Which 1disorder 1of 1the 1thorax 1or 1lung 1does 1this 1best 1describe?
A) Spontaneous 1pneumothorax
B) Chronic 1obstructive 1pulmonary 1disease 1(COPD)
C) Asthma
D) Pneumonia
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Ans: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a
history 1of 1allergies 1and 1can 1be 1made 1worse 1by 1exercise 1or 1irritants 1such 1as 1smoke 1in 1a 1bar.
1On 1auscultation 1there 1can 1be 1normal 1to 1decreased 1air 1movement. 1Wheezing 1is 1heard 1on
1expiration 1and 1sometimes 1inspiration. 1The 1duration 1of 1wheezing 1in 1expiration 1usually
1correlates 1with 1severity 1of 1illness, 1so 1it 1is 1important 1to 1document 1this 1length 1(e.g., 1wheezes
1heard 1halfway 1through 1exhalation). 1Realize 1that 1in 1severe 1asthma, 1wheezes 1may 1not 1be 1heard
1because 1of 1the 1lack 1of 1air 1movement. 1Paradoxically, 1these 1patients 1may 1have 1more 1wheezes
1after 1treatment, 1which 1actually 1indicates 1an 1improvement 1in 1condition. 1 Peak 1flow
1measurements 1help 1to 1discern 1this.
2. A 147-year-old 1receptionist 1comes 1to 1your 1office, 1complaining 1of 1fever, 1shortness 1of 1breath,
1and 1a 1productive 1cough 1with 1golden 1sputum. 1She 1says 1she 1had 1a 1cold 1last 1week 1and 1her
1symptoms 1have 1only 1gotten 1worse, 1despite 1using 1over-the-counter 1cold 1remedies. 1She 1denies
1any 1weight 1gain, 1weight 1loss, 1or 1cardiac 1or 1gastrointestinal 1symptoms. 1Her 1past 1medical
1history 1includes 1type 12 1diabetes 1for 15 1years 1and 1high 1cholesterol. 1She 1takes 1an 1oral 1medication
1for 1both 1diseases. 1She 1has 1had 1no 1surgeries. 1She 1denies 1tobacco, 1alcohol, 1or 1drug 1use. 1Her
1mother 1has 1diabetes 1and 1high 1blood 1pressure. 1Her 1father 1passed 1away 1from 1colon 1cancer. 1On
1examination 1you 1see 1a 1middle-aged 1woman 1appearing 1her 1stated 1age. 1She 1looks 1ill 1and 1her
1temperature 1is 1elevated, 1at 1101. 1Her 1blood 1pressure 1and 1pulse 1are 1unremarkable. 1Her 1head,
1eyes, 1ears, 1nose, 1and 1throat 1examinations 1are 1unremarkable 1except 1for 1edema 1of 1the 1nasal
1turbinates. 1On 1auscultation 1she 1has 1decreased 1air 1movement, 1and 1coarse 1crackles 1are 1heard
1over 1the 1left 1lower 1lobe. 1There 1is 1dullness 1on 1percussion, 1increased 1fremitus 1during 1palpation,
1and 1egophony 1and 1whispered 1pectoriloquy 1on 1auscultation.
What 1disorder 1of 1the 1thorax 1or 1lung 1best 1describes 1her 1symptoms?
A) Spontaneous 1pneumothorax
B) Chronic 1obstructive 1pulmonary 1disease 1(COPD)
C) Asthma
D) Pneumonia
Ans: 1D
Feedback: 1Pneumonia 1is 1usually 1associated 1with 1dyspnea, 1cough, 1and 1fever. 1On 1auscultation
1there 1can 1be 1coarse 1or 1fine 1crackles 1heard 1over 1the 1affected 1lobe. 1Percussion 1over 1the 1affected
1area 1is 1dull 1and 1there 1is 1often 1an 1increase 1in 1fremitus. 1Egophony 1and 1pectoriloquy 1are 1heard
1because 1of 1increased 1transmission 1of 1high-pitched 1components 1of 1sounds. 1These 1higher
1frequencies 1are 1usually 1filtered 1out 1by 1the 1multiple 1air-filled 1chambers 1of 1the 1alveoli.
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Ans: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a
the 1weekend. 1He 1has 1tried 1marijuana 1several 1times 1but 1denies 1any 1other 1illegal 1drugs. 1He 1is 1an
1honors 1student 1and 1is 1on 1thebasketball 1team. 1His 1parents 1are 1both 1in 1good 1health. 1He 1denies
1any 1recent 1weight 1gain, 1weight 1loss, 1fever, 1or 1night 1sweats. 1On 1examination 1you 1see 1a 1tall, 1thin
1young 1man 1in 1obvious 1distress. 1He 1is 1diaphoretic 1and 1is 1breathing 1at 1a 1rate 1of 135 1breaths 1per
1minute. 1On 1auscultation 1you 1hear 1no 1breath 1sounds 1on 1theright 1side 1of 1his 1superior 1chest 1wall.
1On 1percussion 1he 1is 1hyperresonant 1over 1theright 1upper 1lobe. 1With 1palpation 1he 1has 1absent
1fremitus 1over 1theright 1upper 1lobe.
What 1disorder 1of 1thethorax 1or 1lung 1best 1describes 1his 1symptoms?
A) Spontaneous 1pneumothorax
B) Chronic 1obstructive 1pulmonary 1disease 1(COPD)
C) Asthma
D) Pneumonia
Ans: 1A
Feedback: 1Spontaneous 1pneumothorax 1occurs 1suddenly, 1causing 1severe 1dyspnea 1and 1chest 1pain
1on 1theaffected 1side. 1It 1is 1more 1common 1in 1thin 1young 1males. 1On 1auscultation 1of 1theaffected
1side 1there 1will 1be 1no 1breath 1sounds 1and 1on 1percussion 1there 1is 1hyperresonance 1or 1tympany.
1There 1will 1be 1an 1absence 1of 1fremitus 1to 1palpation. 1Given 1this 1young 1man's 1habitus 1and
1pneumothorax, 1you 1may 1consider 1looking 1for 1features 1of 1Marfan's 1syndrome. 1 Read 1more
1about 1this 1condition.
4. A 162-year-old 1construction 1worker 1presents 1to 1your 1clinic, 1complaining 1of 1almost 1a 1year 1of
1chronic 1cough 1and 1occasional 1shortness 1of 1breath. 1Although 1he 1has 1had 1worsening 1of
1symptoms 1occasionally 1with 1a 1cold, 1his 1symptoms 1have 1stayed 1about 1thesame. 1thecough 1has
1occasional 1mucous 1drainage 1but 1never 1any 1blood. 1He 1denies 1any 1chest 1pain. 1He 1has 1had 1no
1weight 1gain, 1weight 1loss, 1fever, 1or 1night 1sweats. 1His 1past 1medical 1history 1is 1significant 1for 1high
1blood 1pressure 1and 1arthritis. 1He 1has 1smoked 1two 1packs 1a 1day 1for 1thepast 145 1years. 1He 1drinks
1occasionally 1but 1denies 1any 1illegal 1drug 1use. 1He 1is 1married 1and 1has 1two 1children. 1He 1denies
1any 1foreign 1travel. 1His 1father 1died 1of 1a 1heart 1attack 1and 1his 1mother 1died 1of 1Alzheimer's
1disease. 1On 1examination 1you 1see 1a 1man 1looking 1slightly 1older 1than 1his 1stated 1age. 1His 1blood
1pressure 1is 1130/80 1and 1his 1pulse 1is 188. 1He 1is 1breathing 1comfortably 1with 1respirations 1of 112.
1His 1head, 1eyes, 1ears, 1nose, 1and 1throat 1examinations 1are 1unremarkable. 1His 1cardiac 1examination
1is 1normal. 1On 1examination 1of 1his 1chest, 1thediameter 1seems 1enlarged. 1Breath 1sounds 1are
1decreased 1throughout 1all 1lobes. 1Rhonchi 1are 1heard 1over 1all 1lung 1fields. 1There 1is 1no 1area 1of
1dullness 1and 1no 1increased 1or 1decreased 1fremitus. 1What 1thorax 1or 1lung 1disorder 1is 1most 1likely
1causing 1his 1symptoms?
A) Spontaneous 1pneumothorax
B) Chronic 1obstructive 1pulmonary 1disease 1(COPD)
C) Asthma
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D) Pneumonia
Ans: B
Feedback: This disorder is insidious in onset and generally affects the older population with a
smoking 1history. 1thediameter 1of 1thechest 1is 1often 1enlarged 1like 1a 1barrel. 1Percussing 1thechest
1elicits 1hyperresonance, 1and 1during 1auscultation 1there 1are 1often 1distant 1breath 1sounds. 1Coarse
1breath 1sounds 1of 1rhonchi 1are 1also 1often 1heard. 1It 1is 1important 1to 1quantify 1this 1patient's
1exercise 1capacity 1because 1it 1may 1affect 1his 1employment 1and 1also 1allows 1you 1to 1follow 1for
1progression 1of 1his 1disease. 1 You 1must 1offer 1smoking 1cessation 1as 1an 1option.
5. A 136-year-old 1teacher 1presents 1to 1your 1clinic, 1complaining 1of 1sharp, 1knifelike 1pain 1on
1theleft 1side 1of 1her 1chest 1for 1thelast 12 1days. 1Breathing 1and 1lying 1down 1make 1thepain 1worse,
1while 1sitting 1forward 1helps 1her 1pain. 1Tylenol 1and 1ibuprofen 1have 1not 1helped. 1Her 1pain 1does
1not 1radiate 1to 1any 1other 1area. 1She 1denies 1any 1upper 1respiratory 1or 1gastrointestinal 1symptoms.
1Her 1past 1medical 1history 1consists 1of 1systemic 1lupus. 1She 1is 1divorced 1and 1has 1one 1child. 1She
1denies 1any 1tobacco, 1alcohol, 1or 1drug 1use. 1Her 1mother 1has 1hypothyroidism 1and 1her 1father 1has
1high 1blood 1pressure. 1On 1examination 1you 1find 1her 1to 1be 1distressed, 1leaning 1over 1and 1holding
1her 1left 1arm 1and 1hand 1to 1her 1left 1chest. 1Her 1blood 1pressure 1is 1130/70, 1her 1respirations 1are 112,
1and 1her 1pulse 1is 190. 1On 1auscultation 1her 1lung 1fields 1have 1normal 1breath 1sounds 1with 1no
1rhonchi, 1wheezes, 1or 1crackles. 1Percussion 1and 1palpation 1are 1unremarkable. 1Auscultation 1of
1theheart 1has 1an 1S1 1 and 1S2 1 with 1no 1S3 1 or 1S4. 1A 1scratching 1noise 1is 1heard 1at 1thelower 1left
1sternal 1border, 1coincident 1with 1systole; 1leaning 1forward 1relieves 1some 1of 1her 1pain. 1She 1is
1nontender 1with 1palpation 1of 1thechest 1wall.
What 1disorder 1of 1thechest 1best 1describes 1this 1disorder?
A) Angina 1pectoris
B) Pericarditis
C) Dissecting 1aortic 1aneurysm
D) Pleural 1pain
Ans: 1B
Feedback: 1thepain 1from 1pericarditis 1is 1usually 1sharp 1and 1knifelike 1and 1is 1located 1over 1theleft
1side 1of 1thechest. 1Change 1of 1position, 1breathing, 1and 1coughing 1often 1make 1thepain 1worse,
1whereas 1leaning 1forward 1improves 1thepain. 1Pericarditis 1is 1often 1seen 1in 1rheumatologic
1diseases 1such 1as 1systemic 1lupus 1and 1in 1patients 1with 1chronic 1kidney 1disease. 1Patients 1also
1experience 1this 1after 1a 1myocardial 1infarction. 1 You 1can 1read 1more 1about 1Dressler's 1syndrome.
6. A 168-year-old 1retired 1postman 1presents 1to 1your 1clinic, 1complaining 1of 1dull, 1intermittent
1left- 1sided 1chest 1pain 1over 1thelast 1few 1weeks. 1thepain 1occurs 1after 1he 1mows 1his 1lawn 1or
1chops 1wood. 1He 1says 1that 1thepain 1radiates 1to 1theleft 1side 1of 1his 1jaw 1but 1nowhere 1else. 1He 1has
1felt 1light-headed
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and nauseated with the pain but has had no other symptoms. He states when he sits down for
several minutes the pain goes away. Ibuprofen, Tylenol, and antacids have not improved his
symptoms. He reports no recent weight gain, weight loss, fever, or night sweats. He has a past
medical history of high blood pressure and arthritis. He quit smoking 10 years ago after smoking
one pack a day for 40 years. He denies any recent alcohol use and reports no drug use. He is
married 1and 1has 1two 1healthy 1children. 1His 1mother 1died 1of 1breast 1cancer 1and 1his 1father 1died 1of 1a
1stroke. 1His 1younger 1brother 1has 1had 1bypass 1surgery. 1On 1examination 1you 1find 1him 1healthy1appearing 1and 1breathing 1comfortably. 1His 1blood 1pressure 1is 1140/90 1and 1he 1has 1a 1pulse 1of 180. 1His
1head, 1eyes, 1ears, 1nose, 1and 1throat 1examinations 1are 1unremarkable. 1His 1lungs 1have 1normal 1breath
1sounds 1and 1there 1are 1no 1abnormalities 1with 1percussion 1and 1palpation 1of 1thechest. 1His 1heart 1has 1a
1normal 1S1 1 and 1S2 1 and 1no 1S3 1 or 1S4. 1Further 1workup 1is 1pending.
Which 1disorder 1of 1thechest 1best 1describes 1these 1symptoms?
A) Angina 1pectoris
B) Pericarditis
C) Dissecting 1aortic 1aneurysm
D) Pleural 1pain
Ans: 1A
Feedback: 1Angina 1causes 1dull 1chest 1pain 1felt 1in 1theretrosternal 1area 1or 1anterior 1chest. 1It 1often
1radiates 1to 1theshoulders, 1arms, 1neck, 1and 1jaw. 1It 1is 1associated 1with 1shortness 1of 1breath, 1nausea,
1and 1sweating. 1thepain 1is 1generally 1relieved 1by 1rest 1or 1medication 1after 1several 1minutes. 1This
1patient 1needs 1to 1be 1admitted 1to 1thehospital 1for 1further 1workup 1for 1his 1accelerating 1symptoms.
7. A 175-year-old 1retired 1teacher 1presents 1to 1your 1clinic, 1complaining 1of 1severe, 1unrelenting
1anterior 1chest 1pain 1radiating 1to 1her 1back. 1She 1describes 1it 1as 1if 1someone 1is 1―ripping 1out 1her
1heart.‖ 1It 1began 1less 1than 1an 1hour 1ago. 1She 1states 1she 1is 1feeling 1very 1nauseated 1and 1may 1pass
1out. 1She 1denies 1any 1trauma 1or 1recent 1illnesses. 1She 1states 1she 1has 1never 1had 1pain 1like 1this
1before. 1Nothing 1seems 1to 1make 1thepain 1better 1or 1worse. 1Her 1medical 1history 1consists 1of
1difficult-to-control 1hypertension 1and 1coronary 1artery 1disease 1requiring 1two 1stents 1in 1thepast.
1She 1is 1a 1widow. 1She 1denies 1any 1alcohol, 1tobacco, 1or 1illegal 1drug 1use. 1Her 1mother 1died 1of 1a
1stroke 1and 1her 1father 1died 1of 1a 1heart 1attack. 1She 1has 1one 1younger 1brother 1who 1has 1had 1bypass
1surgery. 1On 1examination 1you 1see 1an 1elderly 1female 1in 1a 1great 1deal 1of 1distress. 1She 1is 1lying 1on
1thetable, 1curled 1up, 1holding 1her 1left 1and 1right 1arms 1against 1her 1chest 1and 1is 1restless, 1trying 1to
1find 1a 1comfortable 1position. 1Her 1blood 1pressure 1is 1180/110 1in 1theright 1arm 1and 1130/60 1in
1theleft 1arm, 1and 1her 1pulse 1is 1120. 1Her 1right 1carotid 1pulse 1is 1bounding 1but 1theleft 1carotid 1pulse
1is 1weak. 1She 1is 1afebrile 1but 1her 1respirations 1are 124 1times 1a 1minute. 1On 1auscultation 1her 1lungs
1are 1clear 1and 1her 1cardiac 1examination 1is 1unremarkable. 1You 1call 1EMS 1and 1have 1her 1taken 1to
1thehospital's 1ER 1for 1further 1evaluation.
What 1disorder 1of 1thechest 1best 1describes 1her 1symptoms?
A) Angina 1pectoris
B) Pericarditis
C) Dissecting 1aortic 1aneurysm
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D) Pleural pain
Ans: C
Feedback: A dissecting aortic aneurysm is associated with a ripping or tearing sensation that
radiates 1to 1theneck, 1back, 1or 1abdomen. 1Because 1blood 1supply 1to 1thebrain 1and 1extremities 1is
1disrupted, 1syncope 1and 1paraplegia 1or 1hemiplegia 1can 1occur. 1Blood 1pressure 1will 1usually 1be
1different 1between 1thetwo 1arms, 1and 1thecarotid 1pulses 1often 1show 1an 1asymmetry. 1This 1is
1because 1theaneurysm 1decreases 1flow 1distally 1and 1causes 1inequality 1of 1flow 1between 1sides.
8. A 125-year-old 1accountant 1presents 1to 1your 1clinic, 1complaining 1of 1intermittent 1lower 1right1sided 1chest 1pain 1for 1several 1days. 1He 1describes 1it 1as 1knifelike 1and 1states 1it 1only 1lasts 1for 13 1to
15 1seconds, 1taking 1his 1breath 1away. 1He 1states 1he 1feels 1like 1he 1has 1to 1breathe 1shallowly 1to 1keep
1it 1from 1recurring. 1theonly 1thing 1that 1makes 1it 1better 1is 1lying 1quietly 1on 1his 1right 1side. 1It 1is
1much 1worse 1when 1he 1takes 1a 1deep 1breath. 1He 1has 1taken 1some 1Tylenol 1and 1put 1a 1heating 1pad
1on 1his 1side 1but 1neither 1has 1helped. 1He 1remembers 1that 12 1weeks 1ago 1he 1had 1an 1upper
1respiratory 1infection 1with 1a 1severe 1hacking 1cough. 1He 1denies 1any 1recent 1trauma. 1His 1past
1medical 1history 1is 1unremarkable. 1His 1parents 1and 1siblings 1are 1in 1good 1health. 1He 1has 1recently
1married, 1and 1his 1wife 1has 1a 1baby 1due 1in 12 1months. 1He 1denies 1any 1smoking 1or 1illegal 1drug 1use.
1He 1drinks 1two 1to 1three 1beers 1once 1a 1month. 1He 1states 1that 1he 1eats 1a 1healthy 1diet 1and 1runs
1regularly, 1but 1not 1since 1his 1recent 1illness. 1He 1denies 1any 1cardiac, 1gastrointestinal, 1or
1musculoskeletal 1symptoms. 1On 1examination 1he 1is 1lying 1on 1his 1right 1side 1but 1appears 1quite
1comfortable. 1His 1temperature, 1blood 1pressure, 1pulse, 1and 1respirations 1are 1unremarkable. 1His
1chest 1has 1normal 1breath 1sounds 1on 1auscultation. 1Percussion 1of 1thechest 1is 1unremarkable.
1During 1palpation 1theribs 1are 1nontender. 1What 1disorder 1of 1thechest 1best 1describes 1his
1symptoms?
A) Pericarditis
B) Chest 1wall 1pain
C) Pleural 1pain
D) Angina 1pectoralis
Ans: 1C
Feedback: 1This 1pain 1is 1sharp 1and 1knifelike 1and 1occurs 1over 1theaffected 1area 1of 1pleura.
1Breathing 1deeply 1usually 1makes 1thepain 1worse, 1whereas 1lying 1quietly 1on 1theaffected 1side
1makes 1thepain 1better. 1Pleurisy 1often 1occurs 1from 1inflammation 1due 1to 1an 1infection, 1neoplasm,
1or 1autoimmune 1disease.
9. A 160-year-old 1baker 1presents 1to 1your 1clinic, 1complaining 1of 1increasing 1shortness 1of 1breath
1and 1nonproductive 1cough 1over 1thelast 1month. 1She 1feels 1like 1she 1can't 1do 1as 1much 1activity 1as
1she 1used 1to 1do 1without 1becoming 1tired. 1She 1even 1has 1to 1sleep 1upright 1in 1her 1recliner 1at 1night
1to 1be 1able 1to
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breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is
significant for high blood pressure and coronary artery disease. She had a hysterectomy in her
40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She
denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died from
prostate cancer. She denies any recent upper respiratory illness, and she has had no other
symptoms. 1On 1examination 1she 1is 1in 1no 1acute 1distress. 1Her 1blood 1pressure 1is 1160/100 1and 1her
1pulse 1is 1100. 1She 1is 1afebrile 1and 1her 1respiratory 1rate 1is 116. 1With 1auscultation 1she 1has 1distant
1air 1sounds 1and 1she 1has 1late 1inspiratory 1crackles 1in 1both 1lower 1lobes. 1On 1cardiac 1examination
1theS1 1 and 1S2 1 are 1distant 1and 1an 1S3 1 is 1heard 1over 1theapex.
What 1disorder 1of 1thechest 1best 1describes 1her 1symptoms?
A) Pneumonia
B) Chronic 1obstructive 1pulmonary 1disease 1(COPD)
C) Pleural 1pain
D) Left-sided 1heart 1failure
Ans: 1D
Feedback: 1In 1left-sided 1heart 1failure, 1fluid 1starts 1―backing 1up‖ 1into 1thelungs 1because 1theheart 1is
1unable 1to 1handle 1thevolume. 1theexcess 1fluid 1collects 1in 1thedependent 1areas, 1causing 1crackles 1in
1thebases 1of 1thelower 1lobes. 1Sitting 1up 1allows 1patients 1to 1breathe 1easier. 1thetwo 1main 1causes 1are
1chronic 1high 1blood 1pressure 1and 1coronary 1artery 1disease, 1which 1lead 1to 1myocardial 1ischemia 1and
1decreased 1contractility 1of 1theheart.
10. A 1grandmother 1brings 1her 113-year-old 1grandson 1to 1you 1for 1evaluation. 1She 1noticed 1last
1week 1when 1he 1took 1off 1his 1shirt 1that 1his 1breastbone 1seemed 1collapsed. 1He 1seems 1embarrassed
1and 1tells 1you 1that 1it 1has 1been 1that 1way 1for 1quite 1awhile. 1He 1states 1he 1has 1no 1symptoms 1from 1it
1and 1he 1just 1tries 1not 1to 1take 1off 1his 1shirt 1in 1front 1of 1anyone. 1He 1denies 1any 1shortness 1of 1breath,
1chest 1pain, 1or 1lightheadedness 1on 1exertion. 1His 1past 1medical 1history 1is 1unremarkable. 1He 1is 1in
1sixth 1grade 1and 1just 1moved 1in 1with 1his 1grandmother 1after 1his 1father 1was 1deployed 1to
1theMiddle 1East. 1His 1mother 1died 1several 1years 1ago 1in 1a 1car 1accident. 1He 1states 1that 1he 1does
1not 1smoke 1and 1has 1never 1touched 1alcohol. 1On 1examination 1you 1see 1a 1teenage 1boy 1appearing
1his 1stated 1age. 1On 1visual 1examination 1of 1his 1chest 1you 1see 1that 1thelower 1portion 1of 1thesternum
1is 1depressed. 1Auscultation 1of 1thelungs 1and 1heart 1are 1unremarkable.
What 1disorder 1of 1thethorax 1best 1describes 1your 1findings?
A) Barrel 1chest
B) Funnel 1chest 1(pectus 1excavatum)
C) Pigeon 1chest 1(pectus 1carinatum)
D) Thoracic 1kyphoscoliosis
Ans: 1B
Feedback: 1Funnel 1chest 1is 1caused 1by 1a 1depression 1in 1thelower 1portion 1of 1thesternum. 1If 1severe
1enough 1there 1can 1be 1compression 1of 1theheart 1and 1great 1vessels, 1leading 1to 1murmurs 1on
1auscultation. 1 This 1is 1usually 1only 1a 1cosmetic 1problem, 1but 1corrective 1surgeries 1can 1be
1performed
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if necessary.
11. Which 1of 1thefollowing 1anatomic 1landmark 1associations 1is 1correct?
A) 2nd 1intercostal 1space 1for 1needle 1insertion 1in 1tension 1pneumothorax
B) T6 1for 1lower 1margin 1of 1endotracheal 1tube
C) Sternal 1angle 1marks 1the4th 1rib
D) 5th 1intercostal 1space 1for 1chest 1tube 1insertion
Ans: 1A
Feedback: 1the2nd 1intercostal 1space 1is 1indeed 1thecorrect 1location 1for 1insertion 1of 1a 1needle 1in
1tension 1pneumothorax. 1 t 1h 1e 1other 1answers 1are 1incorrect. 1 T4 1marks 1theapproximate
1bifurcation 1of 1thetrachea 1and 1therefore 1marks 1theinferior 1limit 1for 1an 1endotracheal 1tube 1on
1chest 1X-ray. 1thesternal 1angle 1marks 1the2nd 1rib, 1which 1helps 1establish 1the2nd 1interspace 1for
1needle 1insertion 1as 1above 1or 1locations 1for 1cardiac 1auscultation 1(aortic 1and 1pulmonary 1areas).
1Finally, 1the4th 1intercostal 1space 1is 1normally 1used 1for 1chest 1tube 1insertion.
12. A 155–year-old 1smoker 1complains 1of 1chest 1pain 1and 1gestures 1with 1a 1closed 1fist 1over
1her 1sternum 1to 1describe 1it. 1Which 1of 1thefollowing 1diagnoses 1should 1you 1consider 1because
1of 1her 1gesture?
A) Bronchitis
B) Costochondritis
C) Pericarditis
D) Angina 1pectoris
Ans: 1D
Feedback: 1theclenched 1fist 1of 1Levine's 1sign, 1while 1not 1completely 1specific 1for 1ischemic 1pain,
1should 1definitely 1cause 1you 1to 1consider 1this 1etiology. 1Bronchitis 1is 1usually 1painless 1and
1pericarditis 1can 1produce 1a 1sharp 1pain 1which 1worsens 1with 1inspiration. 1This 1is 1called 1pleuritic
1pain 1and 1can 1be 1associated 1with 1pneumonia 1and 1other 1chest 1diseases. 1Costochondritis 1is 1a
1parasternal 1pain, 1usually 1well 1localized. 1 It 1is 1exquisitely 1tender.
13. A 162-year-old 1smoker 1complains 1of 1―coughing 1up 1small 1amounts 1of 1blood,‖ 1so 1you
1consider 1hemoptysis. 1Which 1of 1thefollowing 1should 1you 1also 1consider?
A) Intestinal 1bleeding
B) Hematoma 1of 1thenasal 1septum
C) Epistaxis
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D) Bruising of the tongue
Ans: C
Feedback: 1When 1you 1suspect 1hemoptysis, 1you 1must 1consider 1other 1etiologies 1for 1bleeding.
1Commonly, 1epistaxis 1can 1mimic 1this 1as 1well 1as 1bleeding 1from 1thegastrointestinal 1tract.
1theother 1answers, 1although 1they 1involve 1bleeding, 1are 1contained 1or 1distant 1from 1thepharynx.
14. Which 1of 1thefollowing 1occurs 1in 1respiratory 1distress?
A) Speaking 1in 1sentences 1of 110–20 1words
B) Skin 1between 1theribs 1moves 1inward 1with 1inspiration
C) Neck 1muscles 1are 1relaxed
D) Patient 1torso 1leans 1posteriorly
Ans: 1B
Feedback: 1This 1description 1is 1consistent 1with 1retractions 1that 1occur 1with 1respiratory 1distress.
1Other 1features 1include 1speaking 1in 1short 1sentences, 1use 1of 1accessory 1muscles, 1leaning 1forward
1to 1gain 1mechanical 1advantage 1for 1thediaphragm, 1and 1pursed 1lip 1breathing, 1in 1which 1thepatient
1exhales 1against 1his 1lips, 1which 1are 1pressed 1together.
15. Which 1of 1thefollowing 1is 1consistent 1with 1good 1percussion 1technique?
A) Allow 1all 1of 1thefingers 1to 1touch 1thechest 1while 1performing 1percussion.
B) Maintain 1a 1stiff 1wrist 1and 1hand.
C) Leave 1theplexor 1finger 1on 1thepleximeter 1after 1each 1strike.
D) Strike 1thepleximeter 1over 1thedistal 1interphalangeal 1joint.
Ans: 1D
Feedback: 1 Percussion 1takes 1practice 1to 1master. 1 Most 1struggle 1initially 1with 1keeping 1thewrist
1 and 1hand 1relaxed. 1Other 1challenges 1include 1removing 1theplexor 1quickly 1and 1keeping 1theother
1fingers 1off 1thechest 1wall. 1These 1can 1dampen 1thesound 1you 1are 1trying 1to 1obtain. 1theideal
1targetfor 1theplexor 1is 1thedistal 1interphalangeal 1joint.
16. Which 1of 1thefollowing 1percussion 1notes 1would 1you 1obtain 1over 1thegastric 1bubble?
A) Resonance
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
B) Tympany
C) Hyperresonance
D) Flatness
Ans: B
Feedback: 1thegastric 1bubble 1produces 1one 1of 1thelongest 1percussion 1notes. 1A 1patient 1with
1COPD 1may 1have 1hyperresonance 1over 1his 1chest, 1while 1a 1normal 1person 1would 1have
1resonance. 1Dullness 1is 1heard 1over 1a 1normal 1liver, 1and 1flatness 1is 1heard 1if 1one 1percusses 1a
1large 1muscle.
17. Which 1of 1thefollowing 1conditions 1would 1produce 1a 1hyperresonant 1percussion 1note?
A) Large 1pneumothorax
B) Lobar 1pneumonia
C) Pleural 1effusion
D) Empyema
Ans: 1A
Feedback: 1There 1is 1a 1great 1deal 1of 1free 1air 1in 1thechest 1with 1a 1large 1pneumothorax, 1which
1produces 1a 1hyperresonant 1note. 1theother 1three 1conditions 1produce 1dullness 1by 1dampening
1thepercussion 1note 1with 1fluid.
18. Which 1lung 1sound 1possesses 1thecharacteristics 1of 1being 1louder 1and 1higher 1in 1pitch, 1with
1a 1short 1silence 1between 1inspiration 1and 1expiration 1and 1with 1expiration 1being 1longer 1than
1inspiration?
A) Bronchovesicular
B) Vesicular
C) Bronchial
D) Tracheal
Ans: 1C
Feedback: 1These 1sounds 1are 1consistent 1with 1bronchial 1breath 1sounds. 1Be 1alert 1for 1these, 1as 1they
1may 1occur 1elsewhere 1and 1indicate 1a 1pneumonia 1or 1other 1pathology. 1thecurrent 1explanation 1for
1this 1phenomenon 1is 1that 1thesound 1from 1thetrachea 1is 1carried 1very 1well 1to 1thechest 1wall 1by
1fluid. 1This 1same 1explanation 1explains 1―ee‖ 1to 1―aa‖ 1changes, 1whispered 1pectoriloquy,
1bronchophony, 1and 1other 1circumstances 1in 1which 1high-frequency 1sounds, 1normally 1blocked 1by
1theair-filled 1alveoli, 1could 1be 1transmitted 1to 1thechest 1wall.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
19. A patient complains of shortness of breath for the past few days. On examination, you note
late inspiratory crackles in the lower third of the chest that were not present a week ago. What is
the most likely explanation for these?
A) Asthma
B) COPD
C) Bronchiectasis
D) Heart 1failure
Ans: 1D
Feedback: 1thetiming 1of 1crackles 1within 1inspiration 1provides 1important 1clues. 1These 1late
1inspiratory 1crackles 1that 1appeared 1suddenly 1would 1be 1most 1consistent 1with 1heart 1failure.
1COPD 1and 1asthma 1usually 1produce 1early 1inspiratory 1crackles. 1Bronchiectasis, 1as 1seen 1in 1cystic
1fibrosis, 1classically 1produces 1mid-inspiratory 1crackles, 1but 1this 1is 1not 1always 1reliable.
1Interestingly, 1end- 1expiratory 1crackles 1can 1be 1heard 1in 1asthma 1on 1occasion.
20. When 1crackles, 1wheezes, 1or 1rhonchi 1clear 1with 1a 1cough, 1which 1of 1thefollowing 1is 1a
1likely 1etiology?
A) Bronchitis
B) Simple 1asthma
C) Cystic 1fibrosis
D) Heart 1failure
Ans: 1A
Feedback: 1Adventitious 1sounds 1that 1clear 1with 1cough 1are 1usually 1consistent 1with 1bronchitis
1or 1atelectasis. 1theother 1conditions 1would 1not 1be 1associated 1with 1findings 1that 1cleared 1with 1a
1cough.
21. A 1patient 1with 1longstanding 1COPD 1was 1told 1by 1another 1practitioner 1that 1his 1liver
1was 1enlarged 1and 1this 1needed 1to 1be 1assessed. 1Which 1of 1thefollowing 1would 1be
1reasonable 1to 1do 1next?
A) Percuss 1thelower 1border 1of 1theliver
B) Measure 1thespan 1of 1theliver
C) Order 1a 1hepatitis 1panel
D) Obtain 1an 1ultrasound 1of 1theliver
Ans: 1B
Feedback: 1In 1this 1patient, 1measuring 1thespan 1of 1theliver 1saved 1thepatient 1an 1involved 1workup,
1because 1it 1was 1normal. 1 His 1history 1of 1COPD 1is 1consistent 1with 1flattening 1of 1thediaphragms,
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
which pushed the liver edge down while the actual size of the liver remained the same.
Percussing the lower border of the liver alone caused this referral, because it was assumed that
the liver was enlarged.
22. You 1are 1at 1your 1family 1reunion 1playing 1football 1when 1your 1uncle 1takes 1a 1hit 1to 1his
1right 1lateral 1thorax 1and 1is 1in 1pain. 1He 1asks 1you 1if 1you 1think 1he 1has 1a 1rib 1fracture. 1You 1are
1in 1a 1very 1remote 1area. 1 What 1would 1your 1next 1step 1be?
A) Call 1a 1medevac 1helicopter
B) Drive 1him 1to 1thecity 1(4 1hours 1away)
C) Press 1on 1his 1sternum 1and 1spine 1simultaneously
D) Examine 1him 1for 1tenderness 1over 1theinjured 1area
Ans: 1C
Feedback: 1 t 1h 1e 1area 1involved 1in 1theinjury 1will 1of 1course 1be 1tender. 1 If 1you 1press 1in 1an 1area
1remote 1to 1theinjury, 1but 1over 1thesame 1bone 1which 1may 1be 1involved, 1you 1can 1produce
1tenderness 1at 1thesite 1of 1injury. 1 This 1would 1indicate 1that 1there 1may 1be 1a 1fracture 1at 1thelateral
1ribs.
Fortunately, 1this 1maneuver 1did 1not 1reproduce 1pain 1remotely, 1and 1your 1uncle 1simply 1sat 1on
1thesidelines 1for 1therest 1of 1thegame.
Chapter 114 1theCardiovascular 1System
1
Multiple 1Choice
1. You 1are 1performing 1a 1thorough 1cardiac 1examination. 1Which 1of 1thefollowing 1chambers
1of 1theheart 1can 1you 1assess 1by 1palpation?
A) Left 1atrium
B) Right 1atrium
C) Right 1ventricle
D) Sinus 1node
Ans: 1C
Feedback: 1theright 1ventricle 1occupies 1most 1of 1theanterior 1cardiac 1surface 1and 1is 1easily
1accessible 1to 1palpation. 1 t 1h 1e 1other 1structures 1are 1less 1likely 1to 1have 1findings 1on 1palpation 1and
1thesinus 1node 1is 1an 1intracardiac 1structure. 1You 1may 1be 1able 1to 1diagnose 1abnormal 1rhythms
1caused 1by 1thesinus 1node 1indirectly 1by 1palpation, 1but 1this 1is 1less 1obvious.
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2. What is responsible for the inspiratory splitting of S2?
A) Closure of aortic, then pulmonic valves
B) Closure of mitral, then tricuspid valves
C) Closure of aortic, then tricuspid valves
D) 1Closure 1of 1mitral, 1then 1pulmonic 1valves
Ans: 1A
Feedback: 1During 1inspiration, 1theclosure 1of 1theaortic 1valve 1and 1theclosure 1of 1thepulmonic
1valve 1separate 1slightly, 1and 1this 1may 1be 1heard 1as 1two 1audible 1components, 1instead 1of 1a 1single
1sound. 1Current 1explanations 1of 1inspiratory 1splitting 1include 1increased 1capacitance 1in
1thepulmonary 1vascular 1bed 1during 1inspiration, 1which 1prolongs 1ejection 1of 1blood 1from 1theright
1ventricle, 1delaying 1closure 1of 1thepulmonic 1valve. 1 Because 1thepulmonic 1component 1is 1soft,
1youmay 1not 1hear 1it 1away 1from 1theleft 1second 1intercostal 1space. 1Because 1it 1is 1a 1low-pitched
1sound, 1you 1may 1not 1hear 1it 1unless 1you 1use 1thebell 1of 1your 1stethoscope. 1It 1is 1generally 1easy 1to
1hear 1in 1school-aged 1children, 1and 1it 1is 1easy 1to 1notice 1therespiratory 1variation 1of 1thesplitting.
3. A 125-year-old 1optical 1technician 1comes 1to 1your 1clinic 1for 1evaluation 1of 1fatigue. 1As 1part
1of 1your 1physical 1examination, 1you 1listen 1to 1her 1heart 1and 1hear 1a 1murmur 1only 1at 1thecardiac
1apex. 1Which 1valve 1is 1most 1likely 1to 1be 1involved, 1based 1on 1thelocation 1of 1themurmur?
A) Mitral
B) Tricuspid
C) Aortic
D) Pulmonic
Ans: 1A
Feedback: 1 Mitral 1valve 1sounds 1are 1usually 1heard 1best 1at 1and 1around 1thecardiac 1apex.
4. A 158-year-old 1teacher 1presents 1to 1your 1clinic 1with 1a 1complaint 1of 1breathlessness 1with
1activity. 1thepatient 1has 1no 1chronic 1conditions 1and 1does 1not 1take 1any 1medications, 1herbs, 1or
1supplements. 1Which 1of 1thefollowing 1symptoms 1is 1appropriate 1to 1ask 1about 1in
1thecardiovascular 1review 1of 1systems?
A) Abdominal 1pain
B) Orthopnea
C) Hematochezia
D) Tenesmus
Ans: 1B
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: Orthopnea, which is dyspnea that occurs when the patient is lying down and
improves when the patient sits up, is part of the cardiovascular review of systems and, if positive,
may indicate congestive heart failure.
5. You 1are 1screening 1people 1at 1themall 1as 1part 1of 1a 1health 1fair. 1thefirst 1person 1who 1comes
1for 1screening 1has 1a 1blood 1pressure 1of 1132/85. 1How 1would 1you 1categorize 1this?
A) Normal
B) Prehypertension
C) Stage 11 1hypertension
D) Stage 12 1hypertension
Ans: 1B
Feedback: 1Prehypertension 1is 1considered 1to 1be 1a 1systolic 1blood 1pressure 1from 1120 1to 1139 1and 1a
1diastolic 1BP 1from 180 1to 189. 1Previously, 1this 1was 1considered 1normal. 1JNC 17 1recommends
1taking 1action 1at 1this 1point 1to 1prevent 1worsening 1hypertension. 1Research 1shows 1that 1this
1population 1is 1likely 1to 1progress 1to 1more 1serious 1stages 1of 1hypertension.
6. You 1are 1participating 1in 1a 1health 1fair 1and 1performing 1cholesterol 1screens. 1One 1person 1has
1a 1cholesterol 1of 1225. 1She 1is 1concerned 1about 1her 1risk 1for 1developing 1heart 1disease. 1Which
1of 1thefollowing 1factors 1is 1used 1to 1estimate 1the10-year 1risk 1of 1developing 1coronary 1heart
1disease?
A) Ethnicity
B) Alcohol 1intake
C) Gender
D) Asthma
Ans: 1C
Feedback: 1Gender 1is 1used 1in 1thecalculation 1of 1the10-year 1risk 1for 1developing 1coronary 1heart
1disease, 1because 1men 1have 1a 1higher 1risk 1than 1women.
7. You 1are 1evaluating 1a 140-year-old 1banker 1for 1coronary 1heart 1disease 1risk 1factors. 1He 1has 1a
1history 1of 1hypertension, 1which 1is 1well-controlled 1on 1his 1current 1medications. 1He 1does 1not
1smoke; 1he 1does 145 1minutes 1of 1aerobic 1exercise 1five 1times 1weekly. 1You 1are 1calculating 1his 110year 1coronary 1heart 1disease 1risk. 1Which 1of 1thefollowing 1conditions 1is 1considered 1to 1be 1a
1coronary 1heart 1disease 1risk 1equivalent?
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A) Hypertension
B) Peripheral arterial disease
C) Systemic lupus erythematosus
D) Chronic obstructive pulmonary disease (COPD)
Ans: 1B
Feedback: 1Peripheral 1arterial 1disease 1is 1considered 1to 1be 1a 1coronary 1heart 1disease 1risk
1equivalent, 1as 1are 1abdominal 1aortic 1aneurysm, 1carotid 1atherosclerotic 1disease, 1and 1diabetes
1mellitus.
8. You 1are 1conducting 1a 1workshop 1on 1themeasurement 1of 1jugular 1venous 1pulsation. 1As 1part
1of 1your 1instruction, 1you 1tell 1thestudents 1to 1make 1sure 1that 1they 1can 1distinguish 1between
1thejugular 1venous 1pulsation 1and 1thecarotid 1pulse. 1Which 1one 1of 1thefollowing 1characteristics
1is 1typical 1of 1thecarotid 1pulse?
A) Palpable
B) Soft, 1rapid, 1undulating 1quality
C) Pulsation 1eliminated 1by 1light 1pressure 1on 1thevessel
D) Level 1of 1pulsation 1changes 1with 1changes 1in 1position
Ans: 1A
Feedback: 1thecarotid 1pulse 1is 1palpable; 1thejugular 1venous 1pulsation 1is 1rarely
1palpable. 1thecarotid 1upstroke 1is 1normally 1brisk, 1but 1it 1may 1be 1delayed 1and 1decreased
1as 1in 1aortic 1stenosis 1orbounding 1as 1in 1aortic 1insufficiency.
9. A 168-year-old 1mechanic 1presents 1to 1theemergency 1room 1for 1shortness 1of 1breath. 1You 1are
1concerned 1about 1a 1cardiac 1cause 1and 1measure 1his 1jugular 1venous 1pressure 1(JVP). 1It 1is
1elevated. 1Which 1one 1of 1thefollowing 1conditions 1is 1a 1potential 1cause 1of 1elevated 1JVP?
A) Left-sided 1heart 1failure
B) Mitral 1stenosis
C) Constrictive 1pericarditis
D) Aortic 1aneurysm
Ans: 1C
Feedback: 1One 1cause 1of 1increased 1jugular 1venous 1pressure 1is 1constrictive 1pericarditis. 1Others
1include 1right-sided 1heart 1failure, 1tricuspid 1stenosis, 1and 1superior 1vena 1cava 1syndrome. 1 You
1may 1wish 1to 1read 1about 1these 1conditions.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
10. You are palpating the apical impulse in a patient with heart disease and find that the
amplitude is diffuse and increased. Which of the following conditions could be a potential cause
of an increase in the amplitude of the impulse?
A) Hypothyroidism
B) Aortic 1stenosis, 1with 1pressure 1overload 1of 1theleft 1ventricle
C) Mitral 1stenosis, 1with 1volume 1overload 1of 1theleft 1atrium
D) Cardiomyopathy
Ans: 1B
Feedback: 1Pressure 1overload 1of 1theleft 1ventricle, 1such 1as 1occurs 1in 1aortic 1stenosis, 1may 1result
1in 1an 1increase 1in 1amplitude 1of 1theapical 1impulse. 1theother 1conditions 1should 1decrease
1amplitude 1of 1theapical 1impulse 1or 1not 1be 1palpable 1at 1all.
11. You 1are 1performing 1a 1cardiac 1examination 1on 1a 1patient 1with 1shortness 1of 1breath 1and
1palpitations. 1You 1listen 1to 1theheart 1with 1thepatient 1sitting 1upright, 1then 1have 1him 1change 1to 1a
1supine 1position, 1and 1finally 1have 1him 1turn 1onto 1his 1left 1side 1in 1theleft 1lateral 1decubitus
1position. 1Which 1of 1thefollowing 1valvular 1defects 1is 1best 1heard 1in 1this 1position?
A) Aortic
B) Pulmonic
C) Mitral
D) Tricuspid
Ans: 1C
Feedback: 1theleft 1lateral 1decubitus 1position 1brings 1theleft 1ventricle 1closer 1to 1thechest 1wall,
1allowing 1mitral 1valve 1murmurs 1to 1be 1better 1heard. 1If 1you 1do 1not 1listen 1to 1theheart 1in 1this
1position 1with 1both 1thediaphragm 1and 1bell 1in 1a 1quiet 1room, 1it 1is 1possible 1to 1miss 1significant
1murmurs 1such 1as 1mitral 1stenosis.
12. You 1are 1concerned 1that 1a 1patient 1has 1an 1aortic 1regurgitation 1murmur. 1Which 1is
1thebest 1position 1to 1accentuate 1themurmur?
A) Upright
B) Upright, 1but 1leaning 1forward
C) Supine
D) Left 1lateral 1decubitus
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Ans: B
Feedback: Leaning forward slightly in the upright position brings the aortic valve and the left
ventricular outflow tract closer to the chest wall, so it will be easier to hear the soft diastolic
decrescendo murmur of aortic insufficiency (regurgitation). You can further your ability to hear
this 1soft 1murmur 1by 1having 1thepatient 1hold 1his 1breath 1in 1exhalation.
13. A 168-year-old 1retired 1waiter 1comes 1to 1your 1clinic 1for 1evaluation 1of 1fatigue. 1You 1perform
1a 1cardiac 1examination 1and 1find 1that 1his 1pulse 1rate 1is 1less 1than 160. 1Which 1of 1thefollowing
1conditions 1could 1be 1responsible 1for 1this 1heart 1rate?
A) Second-degree 1A-V 1block
B) Atrial 1flutter
C) Sinus 1arrhythmia
D) Atrial 1fibrillation
Ans: 1A
Feedback: 1A 1second-degree 1A-V 1block 1can 1result 1in 1a 1pulse 1rate 1less 1than 160. 1Atrial 1flutter 1and
1atrial 1fibrillation 1do 1not 1cause 1bradycardia 1unless 1there 1is 1a 1significant 1accompanying 1block.
Sinus 1arrhythmia 1does 1not 1cause 1bradycardia 1and 1represents 1respiratory 1variation 1of 1theheartrate.
14. Where 1is 1thepoint 1of 1maximal 1impulse 1(PMI) 1normally 1located?
A) In 1theleft 15th 1intercostal 1space, 17 1to 19 1cm 1lateral 1to 1thesternum
B) In 1theleft 15th 1intercostal 1space, 110 1to 112 1cm 1lateral 1to 1thesternum
C) In 1theleft 15th 1intercostal 1space, 1in 1theanterior 1axillary 1line
D) In 1theleft 15th 1intercostal 1space, 1in 1themidaxillary 1line
Ans: 1A
Feedback: 1thePMI 1is 1usually 1located 1in 1theleft 15th 1intercostal 1space, 17 1to 19 1centimeters 1lateral
1to 1thesternal 1border. 1If 1it 1is 1located 1more 1laterally, 1it 1usually 1represents 1cardiac 1enlargement.
1Itssize 1should 1not 1be 1greater 1than 1thesize 1of 1a 1US 1quarter, 1or 1about 1an 1inch. 1Left 1ventricular
1enlargement 1should 1be 1suspected 1if 1it 1is 1larger. 1 t 1h 1e 1PMI 1is 1often 1thebest 1place 1to 1listen 1for
1mitral 1valve 1murmurs 1as 1well 1as 1S3 1 and 1S4. 1 t 1h 1e 1PMI 1is 1often 1difficult 1to 1feel 1in 1normal
1patients.
15. Which 1of 1thefollowing 1events 1occurs 1at 1thestart 1of 1diastole?
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
A) Closure of the tricuspid valve
B) Opening of the pulmonic valve
C) Closure of the aortic valve
D) Production of the first heart sound (S1)
Ans: 1C
Feedback: 1At 1thebeginning 1of 1diastole, 1thevalves 1which 1allow 1blood 1to 1exit 1theheart 1close. 1Itis
1thought 1that 1theclosure 1of 1theaortic 1valve 1produces 1thesecond 1heart 1sound 1(S2). 1Closure 1of
1themitral 1valve 1is 1thought 1to 1produce 1thefirst 1heart 1sound 1(S1).
16. Which 1is 1true 1of 1a 1third 1heart 1sound 1(S3)?
A) It 1marks 1atrial 1contraction.
B) It 1reflects 1normal 1compliance 1of 1theleft 1ventricle.
C) It 1is 1caused 1by 1rapid 1deceleration 1of 1blood 1against 1theventricular 1wall.
D) It 1is 1not 1heard 1in 1atrial 1fibrillation.
Ans: 1C
Feedback: 1theS3 1gallop 1is 1caused 1by 1rapid 1deceleration 1of 1blood 1against 1theventricular 1wall.
1S4is 1heard 1with 1atrial 1contraction 1and 1is 1absent 1in 1atrial 1fibrillation 1for 1this 1reason. 1It 1usually
1indicates 1a 1stiff 1or 1thickened 1left 1ventricle 1as 1in 1hypertension 1or 1left 1ventricular 1hypertrophy.
17. Which 1is 1true 1of 1splitting 1of 1thesecond 1heart 1sound?
A) It 1is 1best 1heard 1over 1thepulmonic 1area 1with 1thebell 1of 1thestethoscope.
B) It 1normally 1increases 1with 1exhalation.
C) It 1is 1best 1heard 1over 1theapex.
D) It 1does 1not 1vary 1with 1respiration.
Ans: 1A
Feedback: 1S2 1splitting 1is 1best 1heard 1over 1thepulmonic 1area 1because 1this 1is 1theonly 1place
1where 1both 1of 1its 1components 1can 1be 1heard 1well. 1theclosure 1of 1thepulmonic 1valve 1is 1normally
1not 1loud 1because 1theright 1heart 1is 1a 1low-pressure 1system. 1thebell 1is 1best 1used 1because 1it 1is 1a
1low- 1pitched 1sound. 1 S2 1 splitting 1normally 1increases 1with 1inhalation.
18. Which 1of 1thefollowing 1is 1true 1of 1jugular 1venous 1pressure 1(JVP) 1measurement?
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A) It is measured with the patient at a 45-degree angle.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
C) A JVP below 9 cm is abnormal.
D) It is measured above the sternal notch.
Ans: 1B
Feedback: 1Measurement 1of 1theJVP 1is 1important 1to 1assess 1a 1patient's 1fluid 1status. 1Although 1it
1 may 1be 1measured 1at 145°, 1it 1is 1important 1to 1adjust 1thelevel 1of 1thepatient's 1torso 1so 1that
1theblood 1column 1is 1visible. 1This 1may 1be 1with 1thepatient 1completely 1supine 1or 1sitting
1completely 1upright, 1depending 1on 1thepatient. 1Any 1measurement 1greater 1than 14 1cm 1above
1thesternal 1angle 1is 1abnormal. 1 This 1would 1correspond 1to 1a 1JVP 1of 19 1cm 1because 1we 1add 1a
1constant 1of 15 1cm, 1which 1is 1an 1estimate 1of 1theheight 1of 1thesternal 1notch 1above 1theright 1atrium.
19. Which 1of 1thefollowing 1regarding 1jugular 1venous 1pulsations 1is 1a 1systolic 1phenomenon?
A) The 1―y‖ 1descent
B) The 1―x‖ 1descent
C) The 1upstroke 1of 1the―a‖ 1wave
D) The 1downstroke 1of 1the―v‖ 1wave
Ans: 1B
Feedback: 1 t 1h 1e 1most 1prominent 1upstrokes 1of 1jugular 1venous 1pulsations 1are 1diastolic 1phenomena.
1These 1can 1be 1timed 1using 1thecarotid 1pulse. 1theonly 1event 1listed 1above 1which 1is 1a 1systolic
1phenomenon 1is 1the―x‖ 1descent.
20. How 1much 1does 1cardiovascular 1risk 1increase 1for 1each 1increment 1of 120 1mm 1Hg 1systolic
1and 110 1mm 1Hg 1diastolic 1in 1blood 1pressure?
A) 25%
B) 50%
C) 75%
D) 100%
Ans: 1D
Feedback: 1Each 1increase 1of 1BP 1by 120 1systolic 1and 110 1diastolic 1doubles 1therisk 1of
1cardiovascular 1disease. 1Being 1―low 1risk‖ 1by 1JNC 17 1criteria 1confers 1a 172%–85% 1reduction 1in
1CVD 1mortality 1and 140%–58% 1reduction 1in 1overall 1mortality.
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21. In healthy adults over 20, how often should blood pressure, body mass index, waist
circumference, and pulse be assessed, according to American Heart Association guidelines?
A) Every 6 months
B) Every 1year
C) Every 12 1years
D) Every 15 1years
Ans: 1C
Feedback: 1AHA 1guidelines 1recommend 1screening 1every 12 1years 1in 1patients 1over 120 1for 1blood
1pressure, 1body 1mass 1index, 1waist 1circumference, 1and 1pulse.
22. Which 1of 1thefollowing 1is 1a 1clinical 1identifier 1of 1metabolic 1syndrome?
A) Waist 1circumference 1of 138 1inches 1for 1a 1male
B) Waist 1circumference 1of 134 1inches 1for 1a 1female
C) BP 1of 1134/88 1for 1a 1male
D) BP 1of 1128/84 1for 1a 1female
Ans: 1C
Feedback: 1thephysical 1examination 1criteria 1for 1identifying 1metabolic 1syndrome 1include 1a
1waistof 140 1inches 1or 1greater 1for 1a 1male, 1a 1waist 1of 135 1inches 1or 1greater 1for 1a 1female, 1and 1a
1blood 1pressure 1of 1130/85 1or 1greater. 1Other 1criteria 1include 1triglycerides 1greater 1than 1or 1equal
1to 1150 1mg/dL, 1fasting 1glucose 1greater 1than 1or 1equal 1to 1110 1mg/dL, 1and 1HDL 1less 1than 140 1for
1men 1or 1lessthan 150 1for 1women.
Chapter 115 1thePeripheral 1Vascular 1SystemMultiple
Choice
1. A 157-year-old 1maintenance 1worker 1comes 1to 1your 1office 1for 1evaluation 1of 1pain 1in 1his 1legs.
1He 1has 1smoked 1two 1packs 1per 1day 1since 1theage 1of 116, 1but 1he 1is 1otherwise 1healthy. 1You 1are
1concerned 1that 1he 1may 1have 1peripheral 1vascular 1disease. 1Which 1of 1thefollowing 1is 1part 1of
1common 1or 1concerning 1symptoms 1for 1theperipheral 1vascular 1system?
A) Intermittent 1claudication
B) Chest 1pressure 1with 1exertion
C) Shortness 1of 1breath
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D) Knee pain
Ans: A
Feedback: Intermittent claudication is leg pain that occurs with walking and is relieved by rest.
It 1is 1a 1key 1symptom 1of 1peripheral 1vascular 1disease. 1This 1symptom 1is 1present 1in 1only 1about
1one 1third 1of 1patients 1with 1significant 1arterial 1disease 1and, 1if 1found, 1calls 1for 1more 1aggressive
1management 1of 1cardiovascular 1risk 1factors. 1Screening 1with 1ankle 1brachial 1index 1can 1help
1detect 1this 1problem.
2. A 172-year-old 1teacher 1comes 1to 1your 1clinic 1for 1an 1annual 1examination. 1She 1is 1concerned
1about 1her 1risk 1for 1peripheral 1vascular 1disease 1and 1states 1that 1there 1is 1a 1place 1in 1town 1that 1does
1tests 1to 1 let 1her 1know 1her 1if 1she 1has 1this 1or 1not. 1Which 1of 1thefollowing 1disease 1processes 1is 1a
1risk 1factor 1for 1peripheral 1vascular 1disease?
A) Gastroesophageal 1reflux 1disease
B) Coronary 1artery 1disease
C) Migraine 1headaches
D) Osteoarthritis
Ans: 1B
Feedback: 1Evidence 1of 1coronary 1artery 1disease 1implies 1that 1there 1is 1most 1likely 1disease 1in
1other 1vessels; 1therefore, 1this 1is 1a 1risk 1factor 1for 1peripheral 1vascular 1disease. 1Conversely,
1thepresenceof 1peripheral 1vascular 1disease 1is 1also 1a 1risk 1factor 1for 1coronary 1artery 1disease, 1and
1if 1present, 1it 1should 1be 1considered 1in 1reduction 1of 1cardiac 1risk 1factors.
3. A 168-year-old 1retired 1truck 1driver 1comes 1to 1your 1office 1for 1evaluation 1of 1swelling 1in 1his
1legs. 1He 1is 1a 1smoker 1and 1has 1been 1taking 1medications 1to 1control 1his 1hypertension 1for 1thepast
125 1years. 1You 1are 1concerned 1about 1his 1risk 1for 1peripheral 1vascular 1disease. 1Which 1of
1thefollowing 1tests 1are 1appropriate 1to 1order 1to 1initially 1evaluate 1for 1this 1condition?
A) Venogram
B) CT 1scan 1of 1thelower 1legs
C) Ankle–brachial 1index 1(ABI)
D) PET 1scan
Ans: 1C
Feedback: 1theankle–brachial 1index 1is 1a 1good 1test 1for 1obtaining 1information 1about 1significant
1stenosis 1in 1thevessels 1of 1thelower 1extremities. 1Sixteen 1percent 1of 1patients 1with 1known
1peripheral 1vascular 1disease 1also 1have 1coronary 1artery 1disease.
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4. A 55-year-old secretary with a recent history of breast cancer, for which she underwent
surgery and radiation therapy, and a history of hypertension comes to your office for a routine
checkup. Which of the following aspects of the physical are important to note when assessing the
patient 1for 1peripheral 1vascular 1disease 1in 1thearms?
A) Femoral 1pulse, 1popliteal 1pulse
B) Dorsalis 1pedis 1pulse, 1posterior 1tibial 1pulse
C) Carotid 1pulse
D) Radial 1pulse, 1brachial 1pulse
Ans: 1D
Feedback: 1This 1is 1an 1important 1aspect 1of 1physical 1examination 1to 1assess 1for 1peripheral 1vascular
1disease. 1This 1patient 1is 1at 1risk 1for 1disease 1in 1this 1distribution 1because 1of 1her 1recent 1radiation
1therapy.
5. You 1are 1a 1student 1in 1thevascular 1surgery 1clinic. 1You 1are 1asked 1to 1perform 1a
1physical 1examination 1on 1a 1patient 1with 1known 1peripheral 1vascular 1disease 1in 1thelegs.
1Which 1of 1thefollowing 1aspects 1is 1important 1to 1note 1when 1you 1perform 1your
1examination?
A) Size, 1symmetry, 1and 1skin 1color
B) Muscle 1bulk 1and 1tone
C) Nodules 1in 1joints
D) Lower 1extremity 1strength
Ans: 1A
Feedback: 1This 1is 1an 1important 1aspect 1to 1note 1in 1physical 1examination. 1Swelling 1in 1thelegs,
1cyanosis, 1and 1lack 1of 1appropriate 1hair 1growth 1are 1all 1signs 1of 1peripheral 1vascular 1disease.
6. You 1are 1assessing 1a 1patient 1for 1peripheral 1vascular 1disease 1in 1thearms, 1secondary 1to 1a
1complaint 1of 1increased 1weakness 1and 1a 1history 1of 1coronary 1artery 1disease 1and 1diabetes. 1You
1assess 1thebrachial 1and 1radial 1pulses 1and 1note 1that 1they 1are 1bounding. 1What 1does 1that 1translate
1to 1on 1a 1scale 1of 10 1to 13?
A) 0
B) 3+
C) 2+
D) 1+
Ans: 1B
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Feedback: A pulse of 3+ is considered to be bounding.
7. You 1are 1obtaining 1an 1arterial 1blood 1gas 1in 1theradial 1artery 1on 1a 1retired 1cab 1driver 1who
1has 1been 1hospitalized 1in 1theintensive 1care 1unit 1for 1a 1stroke. 1You 1are 1concerned 1about
1thepossibility 1of 1arterial 1insufficiency. 1You 1perform 1theAllen 1test. 1This 1means 1that 1you:
A) Checked 1for 1patency 1of 1theradial 1artery
B) Checked 1for 1patency 1of 1thebrachial 1artery
C) Checked 1for 1patency 1of 1theulnar 1artery
D) Checked 1for 1patency 1of 1thefemoral 1artery
Ans: 1C
Feedback: 1theAllen 1test 1is 1for 1determining 1patency 1of 1theulnar 1artery 1before 1puncturing
1theradial 1artery. 1In 1theevent 1of 1an 1occlusion 1in 1theradial 1artery 1system, 1theulnar 1artery 1can
1provide 1adequate 1blood 1flow.
8. You 1are 1assessing 1a 159-year-old 1gas 1station 1owner 1for 1atherosclerosis 1in 1thelower
1extremities. 1In 1which 1of 1thefollowing 1locations 1would 1thepatient's 1pain 1make 1you 1concerned
1for 1this 1disease 1process?
A) Thigh
B) Knee
C) Calf
D) Ankle
Ans: 1C
Feedback: 1 Pain 1in 1thecalf 1is 1themost 1common 1site 1for 1claudication; 1however, 1there 1could 1be
1pain 1in 1thebuttock, 1hip, 1thigh, 1or 1foot, 1depending 1on 1thelevel 1of 1theobstruction. 1theabsence
1ofthis 1pain 1does 1not 1rule 1out 1significant 1vascular 1disease, 1and 1actually 1theminority 1of 1these
1patientsare 1symptomatic.
9. You 1are 1performing 1a 1routine 1check-up 1on 1an 181-year-old 1retired 1cotton 1farmer 1in
1thevascular 1surgery 1clinic. 1You 1note 1that 1he 1has 1a 1history 1of 1chronic 1arterial 1insufficiency.
1Which 1of 1thefollowing 1physical 1examination 1findings 1in 1thelower 1extremities 1would 1be
1expected 1with 1this 1disease?
A) Normal 1pulsation
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B) Normal temperature
C) Marked edema
D) Thin, shiny, atrophic skin
Ans: D
Feedback: 1Thin, 1shiny, 1atrophic 1skin 1is 1more 1commonly 1seen 1in 1chronic 1arterial 1insufficiency; 1in
1chronic 1venous 1insufficiency 1theskin 1often 1has 1a 1brown 1pigmentation 1and 1may 1be 1thickened.
10. A 177-year-old 1retired 1nurse 1has 1an 1ulcer 1on 1a 1lower 1extremity 1that 1you 1are 1asked 1to
1evaluate 1when 1you 1do 1your 1weekly 1rounds 1at 1a 1local 1long-term 1care 1facility. 1All 1of
1thefollowing 1are 1responsible 1for 1causing 1ulcers 1in 1thelower 1extremities 1except 1for 1which
1condition?
A) Arterial 1insufficiency
B) Venous 1insufficiency
C) Diminished 1sensation 1in 1pressure 1points
D) Hypertension
Ans: 1D
Feedback: 1Hypertension 1is 1not 1directly 1associated 1with 1theformation 1of 1ulcers. 1It 1is 1an 1indirect
1risk 1factor 1if 1it 1is 1uncontrolled 1for 1a 1long 1time 1and 1associated 1with 1atherosclerosis, 1because 1it
1can 1lead 1to 1arterial 1insufficiency 1or 1neuropathy.
11. As 1theinternal 1diameter 1of 1a 1blood 1vessel 1changes, 1theresistance 1changes 1as 1well. 1Which
1of 1thefollowing 1descriptions 1depicts 1this 1relationship?
A) Resistance 1varies 1linearly 1with 1thediameter.
B) Resistance 1varies 1proportionally 1to 1thesecond 1power 1of 1thediameter.
C) Resistance 1varies 1proportionally 1to 1thethird 1power 1of 1thediameter.
D) Resistance 1varies 1proportionally 1to 1thefourth 1power 1of 1thediameter.
Ans: 1D
Feedback: 1thebody 1is 1able 1to 1make 1significant 1changes 1in 1blood 1vessel 1resistance 1with 1very
1small 1changes 1to 1diameter. 1LaPlace's 1law 1tells 1us 1that 1theresistance 1varies 1proportionally 1to
1thefourth 1power 1of 1thediameter.
12. Which 1area 1of 1thearm 1drains 1to 1theepitrochlear 1nodes?
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A) Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger
B) Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger
C) Ulnar surface of the forearm and hand; second, third, and fourth fingers
D) Radial surface of the forearm and hand; second, third, and fourth fingers
Ans: 1A
Feedback: 1theepitrochlear 1node 1receives 1lymphatic 1drainage 1from 1theulnar 1surface 1of
1theforearm 1and 1hand, 1little 1and 1ring 1fingers, 1and 1ulnar 1middle 1finger. 1More 1importantly,
1it 1is 1generally 1a 1sign 1of 1generalized 1lymphadenopathy 1as 1seen 1in 1syphilis 1and 1HIV
1infection.
13. Mr. 1Edwards 1complains 1of 1cramps 1and 1difficulties 1with 1walking. 1thecramps 1occur 1in
1his 1calves 1consistently 1after 1walking 1about 1100 1yards. 1After 1a 1period 1of 1rest, 1he 1can 1start
1to 1walk 1again, 1but 1after 1100 1yards 1these 1same 1symptoms 1recur. 1Which 1of 1thefollowing
1would 1suggest 1spinal 1stenosis 1as 1a 1cause 1of 1this 1pain?
A) Coldness 1and 1pallor 1of 1thelegs
B) Relief 1of 1thepain 1with 1bending 1at 1thewaist
C) Color 1changes 1of 1theskin
D) Swelling 1with 1tenderness 1of 1theskin
Ans: 1B
Feedback: 1While 1these 1symptoms 1are 1classic 1for 1claudication, 1they 1may 1also 1be 1accounted 1for
1by 1spinal 1stenosis. 1Relief 1with 1bending 1at 1thewaist 1would 1be 1consistent 1with 1this 1etiology.
1 Some 1will 1state 1that 1they 1must 1lean 1over 1theshopping 1cart 1while 1shopping 1to 1avoid 1these
1symptoms.
Bending 1stretches 1thespinal 1cord 1and 1presumably 1decreases 1compression. 1 t 1h 1e 1other
1symptoms 1would 1lead 1one 1to 1suspect 1a 1vascular 1etiology.
14. Which 1of 1thefollowing 1pairs 1of 1ischemic 1symptoms 1versus 1vascular 1supply 1is 1correct?
A) Lower 1calf/superficial 1femoral
B) Erectile 1dysfunction/iliac 1or 1pudendal
C) Buttock/common 1femoral
D) Upper 1calf/tibial 1or 1peroneal
Ans: 1B
Feedback: 1theischemia 1from 1theiliac 1or 1pudendal 1arteries 1results 1in 1erectile 1dysfunction. 1thelower
1calf 1is 1supplied 1by 1thepopliteal 1artery, 1thebuttock 1is 1supplied 1by 1thecommon 1femoral 1artery, 1and
1theupper 1calf 1is 1supplied 1by 1thesuperficial 1femoral 1artery.
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15. The ankle–brachial index (ABI) is calculated by dividing the systolic BP at the dorsalis
pedis 1by 1thesystolic 1BP 1at 1thebrachial 1artery. 1 Which 1of 1thefollowing 1values 1would 1be
1consistent 1with 1mild 1peripheral 1arterial 1disease?
A) 1.1
B) 0.85
C) 0.65
D) 0.35
Ans: 1B
Feedback: 1themild 1disease 1is 1represented 1by 1an 1ABI 1of 10.71 1to 10.9. 1Any 1value 1above 10.9 1is
1normal. 1 Moderate 1disease 1is 1defined 1as 1between 10.7 1and 10.41, 1and 1severe 1disease 1is 1defined
1as
0.4 1or 1less. 1 Patients 1in 1the―severe‖ 1category 1have 1a 120% 1to 125% 1annual 1risk 1of 1death.
16. Asymmetric 1BPs 1are 1seen 1in 1which 1of 1thefollowing 1conditions?
A) Coronary 1artery 1disease
B) Congenital 1narrowing 1of 1theaorta
C) Diffuse 1atherosclerosis
D) Vasculitis, 1as 1seen 1in 1systemic 1lupus 1erythematosus
Ans: 1B
Feedback: 1A 1difference 1of 1as 1little 1as 110 1mm 1Hg 1in 1thesystolic 1blood 1pressure 1may 1be
1significant. 1Coarctation 1and 1dissecting 1aortic 1aneurysm 1are 1causes 1of 1asymmetric 1blood
1pressures. 1Coarctation 1represents 1a 1congenital 1narrowing 1of 1theaorta. 1While 1some 1forms 1of
1vasculitis 1can 1affect 1large 1vessels 1where 1we 1measure 1theblood 1pressure, 1lupus 1is 1generally
1a 1small-vessel 1vasculitis. 1Usually, 1neither 1diffuse 1atherosclerosis 1nor 1coronary 1artery
1disease 1is 1responsible 1for 1a 1focal 1difference 1in 1blood 1pressure.
17. Diminished 1radial 1pulses 1may 1be 1seen 1in 1patients 1with 1which 1of 1thefollowing?
A) Aortic 1insufficiency
B) Hyperthyroidism
C) Arterial 1emboli
D) Early 1―warm‖ 1septic 1shock
Ans: 1C
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Feedback: Arterial emboli would decrease flow to a region, and therefore pulses would decrease
as well. The other conditions actually cause bounding pulses. Aortic insufficiency can cause
significant leakage of blood back to the heart, so the heart compensates by increasing forward
flow. Stroke volume can increase dramatically with hyperthyroidism, especially in ―thyroid
storm.‖ 1This 1also 1results 1in 1bounding 1pulses. 1Although 1shock 1generally 1causes 1decreased 1blood
1pressure 1and 1pulses, 1early 1septic 1shock 1can 1produce 1increased 1peripheral 1circulation 1and
1increase 1pulses.
18. When 1assessing 1temperature 1of 1theskin, 1which 1portion 1of 1your 1hand 1should 1be 1used?
A) Fingertips
B) Palms
C) Backs 1of 1fingers
D) Ulnar 1aspect 1of 1thehand
Ans: 1C
Feedback: 1thebacks 1of 1thefingers 1are 1thought 1to 1be 1themost 1temperature 1sensitive, 1perhaps
1because 1theskin 1is 1thinnest 1there. 1 You 1may 1have 1difficulty 1detecting 1subtle 1differences 1if 1you
1do 1not 1use 1thebacks 1of 1thefingers.
19. A 1patient 1presents 1with 1claudication 1symptoms 1and 1diminished 1pulses. 1 Which
1of 1thefollowing 1is 1consistent 1with 1chronic 1arterial 1insufficiency?
A) Pallor 1of 1thefoot 1when 1raised 1to 160 1degrees 1for 1one 1minute
B) Return 1of 1color 1to 1theskin 1within 15 1seconds 1of 1allowing 1legs 1to 1dangle
C) Filling 1of 1theveins 1of 1theankles 1within 110 1seconds 1of 1allowing 1thelegs 1to 1dangle
D) Hyperpigmentation 1of 1theskin
Ans: 1A
Feedback: 1Pallor 1of 1thesoles 1after 1one 1minute 1of 1elevation 1is 1a 1reliable 1sign 1of 1arterial
1insufficiency. 1Return 1of 1thecolor 1to 1theskin 1should 1occur 1within 110 1seconds 1of 1dangling, 1and
1thefilling 1of 1veins 1should 1occur 1within 115 1seconds. 1Hyperpigmentation 1of 1theskin 1is 1usually 1seen
1in 1venous 1insufficiency.
20. You 1note 1a 1painful 1ulcerative 1lesion 1near 1themedial 1malleolus, 1with
1accompanying 1hyperpigmentation. 1 Which 1of 1thefollowing 1etiologies 1is 1most 1likely?
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A) Arterial insufficiency
B) Neuropathic ulcer
C) Venous insufficiency
D) Trauma
Ans: 1C
Feedback: 1These 1features 1are 1most 1consistent 1with 1venous 1insufficiency. 1You 1may 1also 1see
1scaling, 1redness, 1varicosities, 1and 1other 1findings. 1Arterial 1insufficiency 1usually 1affects 1distal 1or
1traumatized 1areas. 1 Other 1clues 1of 1arterial 1insufficiency 1would 1most 1likely 1be 1present.
Neuropathic 1ulcers 1occur 1because 1of 1decreased 1sensation 1and 1are 1common 1in 1patients 1with
1neuropathy. 1 They 1are 1often 1over 1bony 1prominences 1with 1surrounding 1calluses.
1
Chapter 116 1theGastrointestinal 1and 1Renal 1Systems
Multiple 1Choice
1. A 152-year-old 1secretary 1comes 1to 1your 1office, 1complaining 1about 1accidentally 1leaking 1urine
1when 1she 1coughs 1or 1sneezes. 1She 1says 1this 1has 1been 1going 1on 1for 1about 1a 1year 1now. 1She
1relates 1that 1she 1has 1not 1had 1a 1period 1for 12 1years. 1She 1denies 1any 1recent 1illness 1or 1injuries. 1Her
1past 1medical 1history 1is 1significant 1for 1four 1spontaneous 1vaginal 1deliveries. 1She 1is 1married 1and
1has 1four 1children. 1She 1denies 1alcohol, 1tobacco, 1or 1drug 1use. 1During 1her 1pelvic 1examination 1you
1note 1some 1atrophic 1vaginal 1tissue, 1but 1theremainder 1of 1her 1pelvic, 1abdominal, 1and 1rectal
1examinations 1are 1unremarkable.
Which 1type 1of 1urinary 1incontinence 1does 1she 1have?
A) Stress 1incontinence
B) Urge 1incontinence
C) Overflow 1incontinence
Ans: 1A
Feedback: 1Stress 1incontinence 1usually 1occurs 1when 1theintra-abdominal 1pressure 1goes 1up 1during
1coughing, 1sneezing, 1or 1laughing. 1This 1is 1usually 1due 1to 1a 1weakness 1of 1thepelvic 1floor, 1with
1inadequate 1muscle 1support 1of 1thebladder. 1Vaginal 1deliveries 1and 1pelvic 1surgery 1are 1often
1associated 1with 1these 1symptoms. 1Usually 1female 1patients 1are 1postmenopausal 1when 1stress
1incontinence 1begins. 1Kegel 1exercises 1are 1usually 1recommended 1to 1strengthen 1thepelvic 1floor
1muscles.
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2. A 46-year-old former salesman presents to the ER, complaining of black stools for the past
few weeks. His past medical history is significant for cirrhosis. He has gained weight recently,
especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and
has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and
smoked crack in the past. He denies any recent use. He is currently unemployed and has never
been 1married. 1On 1examination 1you 1find 1a 1man 1appearing 1older 1than 1his 1stated 1age. 1His 1skin 1has 1a
1yellowish 1tint 1and 1he 1is 1thin, 1with 1a 1prominent 1abdomen. 1You 1note 1multiple 1―spider 1angiomas‖ 1at
1thebase 1of 1his 1neck. 1Otherwise, 1his 1heart 1and 1lung 1examinations 1are 1normal. 1On 1inspection 1he 1has
1dilated 1veins 1around 1his 1umbilicus. 1Increased 1bowel 1sounds 1are 1heard 1during 1auscultation.
Palpation 1reveals 1diffuse 1tenderness 1that 1is 1more 1severe 1in 1theepigastric 1area. 1His 1liver 1is 1small
1and 1hard 1to 1palpation 1and 1he 1has 1a 1positive 1fluid 1wave. 1He 1is 1positive 1for 1occult 1blood 1on 1his
1rectal 1examination.
What 1cause 1of 1black 1stools 1most 1likely 1describes 1his 1symptoms 1and 1signs?
A) Infectious 1diarrhea
B) Mallory-Weiss 1tear
C) Esophageal 1varices
Ans: 1C
Feedback: 1Varices 1are 1often 1found 1in 1alcoholic 1patients, 1but 1only 1when 1they 1have 1a 1diagnosis
1of 1significant 1cirrhosis. 1This 1patient 1has 1symptoms 1of 1cirrhosis, 1including 1jaundice, 1ascites,
1spider 1hemangiomas, 1and 1dilated 1veins 1on 1his 1abdomen 1(caput 1medusa).
3. A 121-year-old 1receptionist 1comes 1to 1your 1clinic, 1complaining 1of 1frequent 1diarrhea. 1She
1states 1that 1thestools 1are 1very 1loose 1and 1there 1is 1some 1cramping 1beforehand. 1She 1states 1this 1has
1occurred 1on 1and 1off 1since 1she 1was 1in 1high 1school. 1She 1denies 1any 1nausea, 1vomiting, 1or 1blood
1in 1her 1stool. 1Occasionally 1she 1has 1periods 1of 1constipation, 1but 1that 1is 1rare. 1She 1thinks
1thediarrhea 1is 1much 1worse 1when 1she 1is 1nervous. 1Her 1past 1medical 1history 1is 1not 1significant.
1She 1is 1single 1and 1a 1junior 1in 1college 1majoring 1in 1accounting. 1She 1smokes 1when 1she 1drinks
1alcohol 1but 1denies 1using 1any 1illegal 1drugs. 1Both 1of 1her 1parents 1are 1healthy. 1Her 1entire
1physical 1examination 1is 1unremarkable. 1What 1is 1most 1likely 1theetiology 1of 1her 1diarrhea?
A) Secretory 1infections
B) Inflammatory 1infections
C) Irritable 1bowel 1syndrome
D) Malabsorption 1 syndrome
Ans: 1C
Feedback: 1Irritable 1bowel 1syndrome 1will 1cause 1loose 1bowel 1movements 1with 1cramps 1but
1no 1systemic 1symptoms 1of 1fever, 1weight 1loss, 1or 1malaise. 1This 1syndrome 1is 1more 1likely 1in
1young 1women 1with 1alternating 1symptoms 1of 1loose 1stools 1and 1constipation. 1Stress 1usually
1makes 1thesymptoms 1worse, 1as 1do 1certain 1foods.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
4. A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6
months. 1She 1has 1had 1no 1nausea, 1vomiting, 1or 1diarrhea 1and 1no 1abdominal 1pain 1or 1cramping.
1She 1denies 1any 1recent 1illnesses 1or 1injuries. 1She 1denies 1any 1changes 1to 1her 1diet 1or 1exercise
1program. 1She 1is 1on 1no 1new 1medications. 1During 1thereview 1of 1systems 1you 1note 1that 1she 1has
1felt 1fatigued, 1had 1some 1weight 1gain, 1has 1irregular 1periods, 1and 1has 1cold 1intolerance. 1Her 1past
1medical 1history 1is 1significant 1for 1one 1vaginal 1delivery 1and 1two 1cesarean 1sections. 1She 1is
1married, 1has 1three 1children, 1and 1owns 1a 1flower 1shop. 1She 1denies 1tobacco, 1alcohol, 1or 1drug 1use.
1Her 1mother 1has 1type 12 1 diabetes 1and 1her 1father 1has 1coronary 1artery 1disease. 1There 1is 1no 1family
1history 1of 1cancers. 1On 1examination 1she 1appears 1her 1stated 1age. 1Her 1vital 1signs 1are 1normal. 1Her
1head, 1eyes, 1ears, 1nose, 1throat, 1and 1neck 1examinations 1are 1normal. 1Her 1cardiac, 1lung, 1and
1abdominal 1examinations 1are 1also 1unremarkable. 1Her 1rectal 1occult 1blood 1test 1is 1negative. 1Her
1deep 1tendon 1reflexes 1are 1delayed 1in 1response 1to 1a 1blow 1with 1thehammer, 1especially
1theAchilles 1tendons.
What 1is 1thebest 1choice 1for 1thecause 1of 1her 1constipation?
A) Large 1bowel 1obstruction
B) Irritable 1bowel 1syndrome
C) Rectal 1cancer
D) Hypothyroidism
Ans: 1D
Feedback: 1Many 1metabolic 1conditions 1can 1interfere 1with 1bowel 1motility. 1In 1this 1case
1thepatient 1has 1many 1symptoms 1of 1hypothyroidism, 1including 1cold 1intolerance, 1weight 1gain,
1fatigue, 1constipation, 1and 1irregular 1menstrual 1cycles. 1On 1examination, 1thyromegaly 1and
1delayed 1reflexes 1can 1help 1to 1make 1thediagnosis. 1Medication 1will 1usually 1correct 1these
1symptoms.
5. A 122-year-old 1law 1student 1comes 1to 1your 1office, 1complaining 1of 1severe 1abdominal 1pain
1radiating 1to 1his 1back. 1He 1states 1it 1began 1last 1night 1after 1hours 1of 1heavy 1drinking. 1He 1has 1had
1abdominal 1pain 1and 1vomiting 1in 1thepast 1after 1drinking 1but 1never 1as 1bad 1as 1this. 1He 1cannot
1keep 1any 1food 1or 1water 1down, 1and 1these 1symptoms 1have 1been 1going 1on 1for 1almost 112 1hours.
1He 1has 1had 1no 1recent 1illnesses 1or 1injuries. 1His 1past 1medical 1history 1is 1unremarkable. 1He
1denies 1smoking 1or 1using 1illegal 1drugs 1but 1admits 1to 1drinking 16 1to 110 1beers 1per 1weekend 1night.
1He 1admits 1that 1last 1night 1he 1drank 1something 1like 114 1drinks. 1On 1examination 1you 1find 1a
1young 1male 1appearing 1his 1stated 1age 1in 1some 1distress. 1He 1is 1leaning 1over 1on 1theexamination
1table 1and 1holding 1his 1abdomen 1with 1his 1arms. 1His 1blood 1pressure 1is 190/60 1and 1his 1pulse 1is
1120. 1He 1is 1afebrile. 1His 1abdominal 1examination 1reveals 1normal 1bowel 1sounds, 1but 1he 1is 1very
1tender 1in 1theleft 1upper 1quadrant 1and 1epigastric 1area. 1He 1has 1no 1Murphy's 1sign 1or 1tenderness 1in
1theright 1lower 1quadrant. 1theremainder 1of 1his 1abdominal 1examination 1is 1normal. 1His 1rectal,
1prostate, 1penile, 1and 1testicular 1examinations 1are 1normal. 1He 1has 1no 1inguinal 1hernias 1or
1tenderness 1with 1that 1examination. 1Blood 1work 1is 1pending.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
What etiology of abdominal pain is most likely causing his symptoms?
A) Peptic ulcer disease
B) Biliary colic
C) Acute cholecystitis
D) Acute pancreatitis
Ans: 1D
Feedback: 1Acute 1pancreatitis 1causes 1epigastric 1and 1left 1upper 1quadrant 1pain 1and 1often 1radiates
1into 1theback. 1There 1is 1often 1a 1history 1of 1long-standing 1gallbladder 1disease 1or 1recent 1alcohol
1ingestion. 1Severe 1abdominal 1pain 1and 1vomiting 1are 1often 1seen. 1Medications 1such 1as 1proton
1pump 1inhibitors 1can 1also 1cause 1pancreatitis 1in 1people 1without 1these 1other 1risk 1factors.
1Treatment 1includes 1hydration, 1pain 1management, 1and 1bowel 1rest.
6. A 176-year-old 1retired 1farmer 1comes 1to 1your 1office 1complaining 1of 1abdominal 1pain,
1constipation, 1and 1a 1low-grade 1fever 1for 1about 13 1days. 1He 1denies 1any 1nausea, 1vomiting, 1or
1diarrhea. 1theonly 1unusual 1thing 1he 1remembers 1eating 1is 1two 1bags 1of 1popcorn 1at 1themovies 1with
1his 1grandson, 13 1days 1before 1his 1symptoms 1began. 1He 1denies 1any 1other 1recent 1illnesses. 1His
1past 1medical 1history 1is 1significant 1for 1coronary 1artery 1disease 1and 1high 1blood 1pressure. 1He 1has
1been 1married 1for 1over 150 1years. 1He 1denies 1any 1tobacco, 1alcohol, 1or 1drug 1use. 1His 1mother 1died
1of 1colon 1cancer 1and 1his 1father 1had 1a 1stroke. 1On 1examination 1he 1appears 1his 1stated 1age 1and 1is 1in
1no 1acute 1distress. 1His 1temperature 1is 1100.9 1degrees 1and 1his 1other 1vital 1signs 1are 1unremarkable.
1His 1head, 1cardiac, 1and 1pulmonary 1examinations 1are 1normal. 1He 1has 1normal 1bowel 1sounds 1and 1is
1tender 1over 1theleft 1lower 1quadrant. 1He 1has 1no 1rebound 1or 1guarding. 1His 1rectal 1examination 1is
1unremarkable 1and 1his 1fecal 1occult 1blood 1test 1is 1negative. 1His 1prostate 1is 1slightly 1enlarged 1but
1his 1testicular, 1penile, 1and 1inguinal 1examinations 1are 1all 1normal. 1Blood 1work 1is 1pending.
What 1diagnosis 1for 1abdominal 1pain 1best 1describes 1his 1symptoms 1and 1signs?
A) Acute 1diverticulitis
B) Acute 1cholecystitis
C) Acute 1appendicitis
D) Mesenteric 1ischemia
Ans: 1A
Feedback: 1Diverticulitis 1is 1caused 1by 1localized 1infections 1within 1thecolonic 1diverticula.
1Constipation, 1fever, 1and 1abdominal 1pain 1are 1common. 1Mesenteric 1ischemia 1classically 1presents
1in 1older 1people 1with 1a 1history 1of 1vascular 1disease 1elsewhere. 1thetypical 1pain 1is 1unusual 1in 1that
1it 1is 1not 1made 1worse 1by 1examination 1despite 1being 1severe. 1Some 1mistake 1this 1feature 1to
1indicate 1malingering, 1with 1bad 1results.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
7. A 77-year-old retired bus driver comes to your clinic for a physical examination at his wife's
request. He has recently been losing weight and has felt very fatigued. He has had no chest pain,
shortness of breath, nausea, vomiting, or fever. His past medical history includes colon cancer,
for which he had surgery, and arthritis. He has been married for over 40 years. He denies any
tobacco or drug use and has not drunk alcohol in over 40 years. His parents both died of cancer
in 1their 160s. 1On 1examination 1his 1vital 1signs 1are 1normal. 1His 1head, 1cardiac, 1and 1pulmonary
1examinations 1are 1unremarkable. 1On 1abdominal 1examination 1you 1hear 1normal 1bowel 1sounds,
1but 1when 1you 1palpate 1his 1liver 1it 1is 1abnormal. 1His 1rectal 1examination 1is 1positive 1for 1occult
1blood.
What 1further 1abnormality 1of 1theliver 1was 1likely 1found 1on 1examination?
A) Smooth, 1large, 1nontender 1liver
B) Irregular, 1large 1liver
C) Smooth, 1large, 1tender 1liver
Ans: 1B
Feedback: 1With 1his 1past 1history 1of 1colon 1cancer 1and 1with 1recent 1weight 1loss 1and 1fatigue, 1a
1relapse 1of 1his 1colon 1cancer 1would 1be 1expected. 1Colon 1cancer 1usually 1metastasizes 1to 1theliver,
1creating 1hard, 1irregular 1nodules, 1which 1can 1sometimes 1be 1palpated 1on 1examination. 1A 1smooth,
1large 1liver 1which 1is 1tender 1is 1often 1seen 1in 1hepatitis.
8. A 126-year-old 1sports 1store 1manager 1comes 1to 1your 1clinic, 1complaining 1of 1severe 1right-sided
1abdominal 1pain 1for 112 1hours. 1He 1began 1having 1a 1stomachache 1yesterday, 1with 1a 1decreased
1appetite, 1but 1today 1thepain 1seems 1to 1be 1just 1on 1thelower 1right 1side. 1He 1has 1had 1some 1nausea
1and 1vomiting 1but 1no 1constipation 1or 1diarrhea. 1His 1last 1bowel 1movement 1was 1last 1night 1and
1was 1normal. 1He 1has 1had 1no 1fever 1or 1chills. 1He 1denies 1any 1recent 1illnesses 1or 1injuries. 1His 1past
1medical 1history 1is 1unremarkable. 1He 1is 1engaged. 1He 1denies 1any 1tobacco 1or 1drug 1use 1and 1drinks
1four 1to 1six 1beers 1per 1week. 1His 1mother 1has 1breast 1cancer 1and 1his 1father 1has 1coronary 1artery
1disease. 1On 1examination 1he 1appears 1ill 1and 1is 1lying 1on 1his 1right 1side. 1His 1temperature 1is 1100.4
1and 1his 1heart 1rate 1is 1110. 1His 1bowel 1sounds 1are 1decreased 1and 1he 1has 1rebound 1and 1involuntary
1guarding, 1one 1third 1of 1theway 1between 1theanterior 1superior 1iliac 1spine 1and 1theumbilicus 1in
1theright 1lower 1quadrant. 1His 1rectal, 1inguinal, 1prostate, 1penile, 1and 1testicular 1examinations 1are
1normal.
What 1is 1themost 1likely 1cause 1of 1his 1pain?
A) Acute 1appendicitis
B) Acute 1mechanical 1intestinal 1obstruction
C) Acute 1cholecystitis
D) Mesenteric 1ischemia
Ans: 1A
Feedback: 1Appendicitis 1is 1common 1in 1theyoung 1and 1usually 1presents 1with 1periumbilical 1pain
1that 1localizes 1to 1theright 1lower 1quadrant 1in 1an 1area 1known 1as 1McBurney's 1Point, 1described
1above 1as 1one 1third 1of 1theway 1between 1theanterior 1superior 1iliac 1spine 1and 1theumbilicus 1on
1theright.
Rebound 1and 1guarding 1are 1common. 1Remote 1rebound 1or 1Rovsing's 1sign 1is 1also 1seen 1commonly
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
when the course of appendicitis is advanced. Bowel movements are usually unaffected.
9. A 115-year-old 1high 1school 1freshman 1is 1brought 1to 1theclinic 1by 1his 1mother 1because 1of
1chronic 1diarrhea. 1themother 1states 1that 1for 1thepast 1couple 1of 1years 1her 1son 1has 1had 1diarrhea
1after 1many 1meals. 1thepatient 1states 1that 1thediarrhea 1seems 1theabsolute 1worst 1after 1his 1school
1lunches. 1He 1describes 1his 1symptoms 1as 1cramping 1abdominal 1pain 1and 1gas 1followed 1by 1diarrhea.
1His 1stools 1are 1watery 1with 1no 1specific 1smell. 1He 1denies 1any 1nausea, 1vomiting, 1constipation,
1weight 1loss, 1or 1fatigue. 1He 1has 1had 1no 1recent 1illness, 1injuries, 1or 1foreign 1travel. 1His 1past
1medical 1history 1is 1unremarkable. 1He 1denies 1tobacco, 1alcohol, 1or 1drug 1use. 1His 1parents 1are 1both
1healthy. 1On 1examination 1you 1see 1a 1relaxed 1young 1man 1breathing 1comfortably. 1His 1vital 1signs
1are 1normal 1and 1his 1head, 1eyes, 1ears, 1throat, 1neck, 1cardiac, 1and 1pulmonary 1examinations 1are
1normal. 1His 1abdomen 1is 1soft 1and 1nondistended. 1His 1bowel 1sounds 1are 1active 1and 1he 1has 1no
1tenderness, 1no 1enlarged 1organs, 1and 1no 1rebound 1or 1guarding. 1His 1rectal 1examination 1is
1nontender 1with 1no 1blood 1on 1theglove. 1You 1collect 1a 1stool 1sample 1for 1further 1study.
What 1is 1themost 1likely 1explanation 1for 1this 1patient's 1chronic 1diarrhea?
A) Malabsorption 1syndrome
B) Osmotic 1diarrhea
C) Secretory 1diarrhea
Ans: 1B
Feedback: 1 Usually 1related 1to 1lactose 1intolerance, 1watery 1diarrhea 1often 1follows 1meal 1ingestion.
1Crampy 1abdominal 1pain, 1distension, 1and 1gas 1often 1accompany 1symptoms. 1Diarrhea 1is 1often
1provoked 1by 1pizza, 1milkshakes, 1yogurt, 1and 1other 1lactose-containing 1foods. 1This 1condition 1is
1more 1common 1in 1African-Americans, 1Latinos, 1Native 1Americans, 1and 1Asians.
10. A 127-year-old 1policewoman 1comes 1to 1your 1clinic, 1complaining 1of 1severe 1left-sided 1back
1pain 1radiating 1down 1into 1her 1groin. 1It 1began 1in 1themiddle 1of 1thenight 1and 1woke 1her 1up
1suddenly. 1It 1hurts 1in 1her 1bladder 1to 1urinate 1but 1she 1has 1no 1burning 1on 1theoutside. 1She 1has 1had
1no 1frequency 1or 1urgency 1with 1urination 1but 1she 1has 1seen 1blood 1in 1her 1urine. 1She 1has 1had
1nausea 1with 1thepain 1but 1no 1vomiting 1or 1fever. 1She 1denies 1any 1other 1recent 1illness 1or 1injuries.
1Her 1past 1medical 1history 1is 1unremarkable. 1She 1denies 1tobacco 1or 1drug 1use 1and 1drinks 1alcohol
1rarely. 1Her 1mother 1has 1high 1blood 1pressure 1and 1her 1father 1is 1healthy. 1On 1examination 1she
1looks 1her 1stated 1age 1and 1is 1in 1obvious 1pain. 1She 1is 1lying 1on 1her 1left 1side 1trying 1to 1remain 1very
1still. 1Her 1cardiac, 1pulmonary, 1and 1abdominal 1examinations 1are 1unremarkable. 1She 1has
1tenderness 1just 1inferior 1to 1theleft 1costovertebral 1angle. 1Her 1urine 1pregnancy 1test 1is 1negative 1and
1her 1urine 1analysis 1shows 1red 1blood 1cells.
What 1type 1of 1urinary 1tract 1pain 1is 1she 1most 1likely 1to 1have?
A) Kidney 1pain 1(from 1pyelonephritis)
B) Ureteral 1pain 1(from 1a 1kidney 1stone)
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
C) Musculoskeletal pain
D) Ischemic bowel pain
Ans: B
Feedback: 1thepain 1from 1a 1kidney 1stone 1causes 1dramatic, 1severe, 1colicky 1pain 1at
1thecostovertebral 1angle 1that 1radiates 1across 1theflank 1and 1down 1into 1thegroin.
11. Chris 1is 1a 120-year-old 1college 1student 1who 1has 1had 1abdominal 1pain 1for 13 1days. 1It 1started 1at
1his 1umbilicus 1and 1was 1associated 1with 1nausea 1and 1vomiting. 1He 1was 1unable 1to 1find 1a
1comfortable 1position. 1Yesterday, 1thepain 1became 1more 1severe 1and 1constant. 1Now, 1he 1hesitates
1to 1walk, 1because 1any 1motion 1makes 1thepain 1much 1worse. 1It 1is 1localized 1just 1medial 1and
1inferior 1to 1his 1 iliac 1crest 1on 1theright. 1Which 1of 1thefollowing 1is 1most 1likely?
A) Peptic 1ulcer
B) Cholecystitis
C) Pancreatitis
D) Appendicitis
Ans: 1D
Feedback: 1This 1is 1a 1classic 1history 1for 1appendicitis. 1Notice 1that 1thepain 1has 1changed 1from
1visceral 1to 1parietal. 1It 1is 1well 1localized 1to 1theright 1lower 1quadrant, 1making 1appendicitis 1a
1strong 1consideration.
12. Bill, 1a 155-year-old 1man, 1presents 1with 1pain 1in 1his 1epigastrium 1which 1lasts 1for 130 1minutes
1or 1more 1at 1a 1time 1and 1has 1started 1recently. 1Which 1of 1thefollowing 1should 1be 1considered?
A) Peptic 1ulcer
B) Pancreatitis
C) Myocardial 1ischemia
D) All 1of 1theabove
Ans: 1D
Feedback: 1Epigastric 1pain 1can 1have 1many 1causes. 1History 1and 1physical 1will 1help 1discern 1which
1causes 1are 1most 1likely, 1but 1it 1is 1important 1to 1realize 1that 1any 1of 1theabove, 1including
1myocardial 1ischemia, 1is 1always 1a 1possibility. 1Pneumonia 1and 1gallbladder 1pain 1can 1also 1cause
1pain 1in 1this 1location.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
13. Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal
pain approximately one week a month for the past year. It is not related to her menses. She notes
relief with defecation, and a change in form and frequency of her bowel movements with these
episodes. Which of the following is most likely?
A) Colon 1cancer
B) Cholecystitis
C) Inflammatory 1bowel 1disease
D) Irritable 1bowel 1syndrome
Ans: 1D
Feedback: 1 Although 1colon 1cancer 1should 1be 1a 1consideration, 1these 1symptoms 1are 1intermittent
1 and 1no 1note 1is 1made 1of 1progression. 1Cholecystitis 1usually 1presents 1with 1right 1upper 1quadrant
1 pain. 1Inflammatory 1bowel 1disease 1is 1often 1associated 1with 1fever 1and 1hematochezia. 1Because
1there 1is 1relief 1with 1defecation 1and 1there 1are 1no 1mentioned 1structural 1or 1biochemical
1abnormalities, 1irritable 1bowel 1syndrome 1seems 1most 1likely. 1This 1is 1a 1very 1common 1condition
1which 1can 1be 1triggered 1by 1certain 1foods 1and 1stress.
14. Jim 1is 1a 160-year-old 1man 1who 1presents 1with 1vomiting. 1He 1denies 1seeing 1any 1blood 1with
1emesis, 1which 1has 1been 1occurring 1for 12 1days. 1He 1does 1note 1a 1dark, 1granular 1substance
1resembling 1thecoffee 1left 1in 1thefilter 1after 1brewing. 1What 1do 1you 1suspect?
A) Bleeding 1from 1a 1diverticulum
B) Bleeding 1from 1a 1peptic 1ulcer
C) Bleeding 1from 1a 1colon 1cancer
D) Bleeding 1from 1cholecystitis
Ans: 1B
Feedback: 1When 1blood 1is 1exposed 1to 1theenvironment 1of 1thestomach, 1it 1often 1resembles 1―coffee
1grounds.‖ 1This 1is 1not 1always 1recognized 1by 1patients 1as 1blood, 1so 1it 1is 1important 1to 1inquire
1about 1this. 1This 1symptom 1is 1not 1common 1in 1cholecystitis, 1and 1theother 1possibilities 1occur
1lower 1in 1theintestine. 1It 1should 1be 1noted 1that 1conversely, 1rapid 1bleeding 1from 1thestomach 1or
1other 1upper 1gastrointestinal 1source 1can 1produce 1bright 1red 1blood 1in 1thestool. 1Do 1not 1rule 1out
1proximal 1bleeding 1on 1thebasis 1of 1theabsence 1of 1―coffee 1grounds.‖ 1Likewise, 1bright 1red 1blood
1seen 1with 1emesis 1may 1originate 1from 1thestomach. 1Black, 1sticky 1stools 1also 1can 1accompany
1upper 1GI 1bleeding.
15. A 1daycare 1worker 1presents 1to 1your 1office 1with 1jaundice. 1She 1denies 1IV 1drug 1use,
1blood 1transfusion, 1and 1travel 1and 1has 1not 1been 1sexually 1active 1for 1thepast 110 1months.
1Which 1type 1of
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
hepatitis is most likely?
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
Ans: 1A
Feedback: 1thelack 1of 1contact 1with 1blood 1and 1body 1fluids 1makes 1hepatitis 1B, 1C, 1and 1D
1unlikely.She 1regularly 1changes 1thediapers 1of 1her 1clients 1and 1is 1at 1risk 1for 1hepatitis 1A. 1Vaccine
1against 1hepatitis 1A 1is 1recommended 1for 1daycare 1workers.
16. Linda 1is 1a 129-year-old 1who 1had 1excruciating 1pain 1which 1started 1under 1her 1lower 1ribs
1on 1theright 1side. 1thepain 1eventually 1moved 1to 1her 1lateral 1abdomen 1and 1then 1into 1her 1right
1lower 1quadrant. 1Which 1is 1most 1likely, 1given 1this 1presentation?
A) Appendicitis
B) Dysmenorrhea
C) Ureteral 1stone
D) Ovarian 1cyst
Ans: 1C
Feedback: 1thepresentation 1of 1right 1flank 1pain 1spiraling 1down 1to 1thegroin 1is 1typical 1of 1a 1ureteral
1stone. 1There 1would 1most 1likely 1be 1microscopic 1hematuria 1as 1well. 1themigration 1pattern 1of 1this
1condition 1makes 1theothers 1less 1likely.
17. Mrs. 1LaFarge 1is 1a 160-year-old 1who 1presents 1with 1urinary 1incontinence. 1She 1is 1unable 1to
1get 1to 1thebathroom 1quickly 1enough 1when 1she 1senses 1theneed 1to 1urinate. 1She 1has 1normal
1mobility. 1Which 1of 1thefollowing 1is 1most 1likely?
A) Stress 1incontinence
B) Urge 1incontinence
C) Overflow 1incontinence
D) Functional 1incontinence
Ans: 1B
Feedback: 1Stress 1incontinence 1occurs 1with 1increased 1intra-abdominal 1pressure 1such 1as 1with
1coughing, 1sneezing, 1or 1laughing. 1This 1history 1is 1most 1consistent 1with 1urge 1incontinence
1secondary 1to 1detrusor 1overactivity. 1Overflow 1incontinence 1occurs 1with 1anatomic 1obstruction
1such 1as 1prostatic 1hypertrophy 1(obviously 1not 1in 1this 1case, 1as 1thepatient 1is 1a 1woman), 1urethral
1stricture, 1or 1neurogenic 1bladder. 1Functional 1incontinence 1results 1from 1lack 1of 1mobility 1severe
1enough 1to
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
impair getting to the bathroom quickly enough.
18. Which 1is 1theproper 1sequence 1of 1examination 1for 1theabdomen?
A) Auscultation, 1inspection, 1palpation, 1percussion
B) Inspection, 1percussion, 1palpation, 1auscultation
C) Inspection, 1auscultation, 1percussion, 1palpation
D) Auscultation, 1percussion, 1inspection, 1palpation
Ans: 1C
Feedback: 1 t 1h 1e 1abdominal 1examination 1is 1conducted 1in 1a 1sequence 1different 1from 1other
1systems, 1for 1which 1theusual 1order 1is 1inspection, 1percussion, 1palpation, 1and 1auscultation.
1Because 1palpation 1may 1actually 1cause 1some 1bowel 1noise 1when 1thebowels 1are 1not 1moving,
1auscultation 1is 1performed 1before 1percussion 1and 1palpation 1in 1an 1abdominal 1examination.
19. A 162-year-old 1woman 1has 1been 1followed 1by 1you 1for 13 1years 1and 1has 1had 1recent 1onset 1of
1hypertension. 1She 1is 1still 1not 1at 1goal 1despite 1three 1antihypertensive 1medicines, 1and 1you
1strongly 1doubt 1nonadherence. 1Her 1father 1died 1of 1a 1heart 1attack 1at 1age 158. 1Today 1her 1pressure 1is
1168/94 1and 1pressure 1on 1theother 1arm 1is 1similar. 1What 1would 1you 1do 1next?
A) Add 1a 1fourth 1medicine
B) Refer 1to 1nephrology
C) Get 1a 1CT 1scan
D) Listen 1closely 1to 1her 1abdomen
Ans: 1D
Feedback: 1At 1this 1point, 1it 1is 1important 1to 1consider 1secondary 1causes 1for 1this 1woman's
1hypertension 1because 1of 1its 1severity, 1rapidity 1of 1progression, 1and 1lack 1of 1response 1to 1therapy.
1While 1you 1will 1most 1likely 1add 1a 1fourth 1medicine, 1it 1is 1important 1to 1carefully 1examine
1theabdomen 1for 1thepresence 1of 1renal 1artery 1bruits. 1These 1are 1usually 1heard 1best 1in 1theupper
1quadrants. 1It 1may 1be 1necessary 1to 1have 1thepatient 1hold 1her 1breath, 1to 1have 1a 1very 1quiet 1room,
1and 1to 1listen 1with 1thediaphragm 1for 1a 1very 1soft, 1high-pitched 1sound 1with 1systole. 1It 1may 1also
1help 1to 1simultaneously 1feel 1thepatient's 1pulse 1(a 1bruit 1with 1both 1a 1systolic 1and 1diastolic
1component 1is 1very 1specific 1for 1a 1significant 1blockage, 1while 1a 1lone 1systolic 1bruit 1may 1not 1be
1abnormal).
Obtaining 1a 1CT 1scan 1is 1not 1likely 1to 1be 1useful, 1and 1you 1may 1save 1thedelay, 1expense, 1and
1inconvenience 1of 1a 1nephrology 1referral 1if 1you 1can 1hear 1a 1bruit.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
20. Mr. Patel is a 64-year-old man who was told by another care provider that his liver is
enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no
knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below
the costal arch. Which of the following would you do next?
A) Check an ultrasound of the liver
B) Obtain 1a 1hepatitis 1panel
C) Determine 1liver 1span 1by 1percussion
D) Adopt 1a 1―watchful 1waiting‖ 1approach
Ans: 1C
Feedback: 1A 1liver 1edge 1palpable 1this 1far 1below 1thecostal 1arch 1should 1not 1be 1ignored.
1Ultrasound 1and 1laboratory 1investigation 1are 1reasonable 1if 1theliver 1is 1actually 1enlarged. 1Mr.
1Patel 1has 1developed 1emphysema 1with 1flattening 1of 1thediaphragms. 1This 1pushes 1a 1normal-sized
1liver 1below 1thecostal 1arch 1so 1that 1it 1appears 1to 1be 1enlarged. 1A 1liver 1span 1should 1be 1determined
1by 1percussing 1down 1thechest 1wall 1until 1dullness 1is 1heard. 1A 1measurement 1is 1then 1made
1between 1this 1point 1and 1thelower 1border 1of 1theliver 1to 1determine 1its 1span; 16–12 1centimeters 1in
1themid-clavicular 1line 1is 1normal. 1Percussion 1is 1theonly 1way 1to 1assess 1liver 1size 1on
1examination, 1and 1in 1this 1case 1it 1saved 1thepatient 1much 1inconvenience 1and 1expense.
21. Cody 1is 1a 1teenager 1with 1a 1history 1of 1leukemia 1and 1an 1enlarged 1spleen. 1Today 1he 1presents
1with 1fairly 1significant 1left 1upper 1quadrant 1pain. 1On 1examination 1of 1this 1area 1a 1rough 1grating
1noise 1is 1heard. 1What 1is 1this 1sound?
A) It 1is 1a 1splenic 1rub.
B) It 1is 1a 1variant 1of 1bowel 1noise.
C) It 1represents 1borborygmi.
D) It 1is 1a 1vascular 1noise.
Ans: 1A
Feedback: 1 A 1rough, 1grating 1noise 1over 1this 1area 1represents 1a 1splenic 1rub, 1which 1can
1accompany 1splenic 1infarction. 1Rubs 1also 1occur 1over 1theliver 1and 1pleura 1and 1pericardium.
22. You 1are 1palpating 1theabdomen 1and 1feel 1a 1small 1mass. 1Which 1of 1thefollowing 1would 1you
1do 1next?
A) Ultrasound
B) Examination 1with 1theabdominal 1muscles 1tensed
C) Surgery 1referral
D) Determine 1size 1by 1percussion
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Ans: B
Feedback: It is easy to determine whether the mass is actually in the abdominal wall versus in
the abdomen by palpating with the abdominal wall tensed. This can be accomplished by having
the patient lift her head off the bed while supine. Usually, abdominal wall masses can be
observed, 1whereas 1intra-abdominal 1masses 1are 1more 1concerning.
23. Josh 1is 1a 114-year-old 1boy 1who 1presents 1with 1a 1sore 1throat. 1On 1examination, 1you
1notice 1dullness 1in 1thelast 1intercostal 1space 1in 1theanterior 1axillary 1line 1on 1his 1left 1side
1with 1a 1deep 1breath. 1What 1does 1this 1indicate?
A) His 1spleen 1is 1definitely 1enlarged 1and 1further 1workup 1is 1warranted.
B) His 1spleen 1is 1possibly 1enlarged 1and 1close 1attention 1should 1be 1paid 1to 1further 1examination.
C) His 1spleen 1is 1possibly 1enlarged 1and 1further 1workup 1is 1warranted.
D) His 1spleen 1is 1definitely 1normal.
Ans: 1B
Feedback: 1This 1scenario 1is 1not 1uncommon 1in 1infectious 1mononucleosis. 1thepresence 1of
1dullness 1with 1inspiration 1should 1definitely 1increase 1your 1attention 1to 1further 1examination 1of
1thespleen, 1although 1dullness 1can 1occur 1in 1normal 1patients 1too.
24. A 1young 1patient 1presents 1with 1a 1left-sided 1mass 1in 1her 1abdomen. 1You 1confirm 1that 1it 1is
1present 1in 1theleft 1upper 1quadrant. 1Which 1of 1thefollowing 1would 1support 1that 1this 1represents
1an 1enlarged 1kidney 1rather 1than 1her 1spleen?
A) A 1palpable 1―notch‖ 1along 1its 1edge
B) The 1inability 1to 1push 1your 1fingers 1between 1themass 1and 1thecostal 1margin
C) The 1presence 1of 1normal 1tympany 1over 1this 1area
D) The 1ability 1to 1push 1your 1fingers 1medial 1and 1deep 1to 1themass
Ans: 1C
Feedback: 1A 1left 1upper 1quadrant 1mass 1is 1more 1likely 1to 1be 1a 1kidney 1if 1there 1is 1no 1palpable
―notch,‖ 1you 1can 1push 1your 1fingers 1between 1themass 1and 1thecostal 1margin, 1there 1is 1normal
1tympany 1over 1this 1area, 1and 1you 1cannot 1push 1your 1fingers 1medial 1and 1deep 1to 1themass. 1These
1findings 1are 1very 1difficult 1to 1appreciate 1in 1an 1obese 1patient.
25. Mr. 1Kruger 1is 1an 184-year-old 1who 1presents 1with 1a 1smooth 1lower 1abdominal 1mass 1in 1the
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the
symphysis pubis. What does this most likely represent?
A) Sigmoid mass
B) Tumor in the abdominal wall
C) Hernia
D) 1Enlarged 1bladder
Ans: 1D
Feedback: 1It 1is 1possible 1that 1this 1represents 1a 1sigmoid 1colon 1mass, 1but 1this 1is 1less 1likely 1than 1an
1enlarged 1bladder. 1Prostatic 1hypertrophy 1is 1very 1common 1in 1this 1age 1group 1and 1can 1frequently
1cause 1partial 1urinary 1obstruction 1with 1bladder 1enlargement. 1If 1themass 1resolves 1with
1catheterization, 1this 1is 1a 1likely 1cause. 1Other 1forms 1of 1urinary 1obstruction 1such 1as 1neurogenic
1bladder, 1urethral 1stricture, 1and 1side 1effects 1of 1drugs 1can 1also 1be 1contributing 1to 1theproblem. 1A
1hernia 1would 1most 1likely 1not 1be 1dull 1to 1percussion. 1Midline 1abdominal 1wall 1tumors 1of 1this
1size 1would 1be 1unusual 1but 1could 1be 1discerned 1by 1having 1thepatient 1tense 1his 1abdominal
1muscles.
26. Mr. 1Martin 1is 1a 172-year-old 1smoker 1who 1comes 1to 1you 1for 1his 1hypertension 1visit. 1You 1note
1that 1with 1deep 1palpation 1you 1feel 1a 1pulsatile 1mass 1which 1is 1about 14 1centimeters 1in 1diameter.
1What 1should 1you 1do 1next?
A) Obtain 1abdominal 1ultrasound
B) Reassess 1by 1examination 1in 16 1months
C) Reassess 1by 1examination 1in 13 1months
D) Refer 1to 1a 1vascular 1surgeon
Ans: 1A
Feedback: 1A 1pulsatile 1mass 1in 1this 1man 1should 1be 1followed 1up 1with 1ultrasound 1as 1soon 1as
1possible. 1His 1risk 1of 1aortic 1rupture 1is 1at 1least 115 1times 1greater 1if 1his 1aorta 1measures 1more 1than
14 1centimeters. 1It 1would 1be 1inappropriate 1to 1recheck 1him 1at 1a 1later 1time 1without 1taking 1action.
Likewise, 1referral 1to 1a 1vascular 1surgeon 1before 1ultrasound 1may 1be 1premature.
27. Mr. 1Maxwell 1has 1noticed 1that 1he 1is 1gaining 1weight 1and 1has 1increasing 1girth. 1Which
1of 1thefollowing 1would 1argue 1for 1thepresence 1of 1ascites?
A) Bilateral 1flank 1tympany
B) Dullness 1which 1remains 1despite 1change 1in 1position
C) Dullness 1centrally 1when 1thepatient 1is 1supine
D) Tympany 1which 1changes 1location 1with 1patient 1position
Ans: 1D
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: A diagnosis of ascites is supported by findings that are consistent with movement of
fluid and gas with changes in position. Gas-filled loops of bowel tend to float so that dullness
when supine would argue against this. Likewise, because fluid gathers in dependent areas, the
flanks should ordinarily be dull with ascites. Tympany which changes location with patient
position 1(―shifting 1dullness‖) 1would 1support 1thepresence 1of 1ascites. 1A 1fluid 1wave 1and 1edemawould
1support 1this 1diagnosis 1as 1well.
28. Which 1of 1thefollowing 1is 1consistent 1with 1obturator 1sign?
A) Pain 1distant 1from 1thesite 1used 1to 1check 1rebound 1tenderness
B) Right 1hypogastric 1pain 1with 1theright 1hip 1and 1knee 1flexed 1and 1thehip 1internally 1rotated
C) Pain 1with 1extension 1of 1theright 1thigh 1while 1thepatient 1is 1on 1her 1left 1side 1or 1while
1pressing 1her 1knee 1against 1your 1hand 1with 1thigh 1flexion
D) Pain 1that 1stops 1inhalation 1in 1theright 1upper 1quadrant
Ans: 1B
Feedback: 1Obturator 1sign 1is 1seen 1in 1appendicitis. 1It 1is 1pain 1with 1thestretching 1of 1theinternal
1obturator 1muscle 1because 1of 1inflammation. 1Pain 1distant 1from 1thesite 1used 1to 1check 1rebound
1tenderness 1is 1Rovsing's 1sign 1and 1is 1a 1reliable 1sign 1of 1peritonitis. 1Answer 1―C‖ 1describes 1psoas
1sign, 1which 1is 1also 1seen 1in 1appendicitis. 1Palpation 1in 1theright 1upper 1quadrant 1that 1causes 1pain
1severe 1enough 1to 1stop 1inhalation 1is 1consistent 1with 1inflammation 1of 1thegallbladder 1and 1is
1called 1Murphy's 1sign.
29. An 1elderly 1woman 1with 1a 1history 1of 1coronary 1bypass 1comes 1in 1with 1severe, 1diffuse,
1abdominal 1pain. 1Strangely, 1during 1your 1examination, 1thepain 1is 1not 1made 1worse 1by 1pressing
1on 1theabdomen. 1What 1do 1you 1suspect?
A) Malingering
B) Neuropathy
C) Ischemia
D) Physical 1abuse
Ans: 1C
Feedback: 1Ischemic 1pain 1can 1be 1severe 1but 1is 1not 1made 1worse 1with 1palpation. 1thehistory 1of
1bypass 1could 1be 1a 1clue 1that 1there 1is 1vascular 1narrowing 1elsewhere. 1Malingering 1is 1less 1likely,
1and 1neuropathic 1pain, 1as 1seen 1in 1herpes 1zoster, 1would 1worsen 1with 1touch. 1You 1are 1to 1be
1commended 1if 1you 1considered 1elder 1abuse, 1because 1this 1is 1frequently 1missed. 1Ordinarily, 1this
1pain 1would 1be 1worse 1with 1examination 1because 1of 1thepreceding 1trauma.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Chapter 17 The Breasts and Axillae
Multiple 1Choice
1. A 172-year-old 1retired 1saleswoman 1comes 1to 1your 1office, 1complaining 1of 1a 1bloody 1discharge
1from 1her 1left 1breast 1for 13 1months. 1She 1denies 1any 1trauma 1to 1her 1breast. 1Her 1past 1medical
1history 1includes 1high 1blood 1pressure 1and 1abdominal 1surgery 1for 1colon 1cancer. 1Her 1aunt 1died 1of
1ovarian 1cancer 1and 1her 1father 1died 1of 1colon 1cancer. 1Her 1mother 1died 1of 1a 1stroke. 1thepatient
1denies 1tobacco, 1alcohol, 1or 1drug 1use. 1She 1is 1a 1widow 1and 1has 1three 1healthy 1children. 1On
1examination 1her 1breasts 1are 1symmetric, 1with 1no 1skin 1changes. 1You 1are 1able 1to 1express 1bloody
1discharge 1from 1her 1left 1nipple. 1You 1feel 1no 1discrete 1masses, 1but 1her 1left 1axilla 1has 1a 1hard, 11cm 1fixed 1node. 1theremainder 1of 1her 1heart, 1lung, 1abdominal, 1and 1pelvic 1examinations 1are
1unremarkable.
What 1cause 1of 1nipple 1discharge 1is 1themost 1likely 1in 1her 1circumstance?
A) Benign 1breast 1abnormality
B) Breast 1cancer
C) Galactorrhea
Ans: 1B
Feedback: 1Nipple 1discharge 1in 1breast 1cancer 1is 1usually 1unilateral 1and 1can 1be 1clear 1or 1bloody.
1Although 1a 1breast 1mass 1is 1not 1palpated, 1in 1this 1case 1a 1fixed 1lymph 1node 1is 1palpated. 1Other
1forms 1of 1breast 1cancer 1can 1present 1as 1a 1chronic 1rash 1on 1thebreast.
2. A 144-year-old 1female 1comes 1to 1your 1clinic, 1complaining 1of 1severe 1dry 1skin 1in 1thearea 1over
1her 1right 1nipple. 1She 1denies 1any 1trauma 1to 1thearea. 1She 1noticed 1theskin 1change 1during 1a 1self1examination 12 1months 1ago. 1She 1also 1admits 1that 1she 1had 1felt 1a 1lump 1under 1thenipple 1but 1kept
1putting 1off 1making 1an 1appointment. 1She 1does 1admit 1to 16 1months 1of 1fatigue 1but 1no 1weight
1loss, 1weight 1gain, 1fever, 1or 1night 1sweats. 1Her 1past 1medical 1history 1is 1significant 1for
1hypothyroidism. 1She 1does 1not 1have 1a 1history 1of 1eczema 1or 1allergies. 1She 1denies 1any 1tobacco,
1alcohol, 1or 1drug 1use. 1On 1examination 1you 1find 1a 1middle-aged 1woman 1appearing 1her 1stated 1age.
1Inspection 1of 1her 1right 1breast 1reveals 1a 1scaly 1eczema-like 1crust 1around 1her 1nipple. 1Underneath
1you 1palpate 1a 1nontender 12-cm 1mass. 1theaxilla 1contains 1only 1soft, 1moveable 1nodes. 1theleft
1breast 1and 1axilla 1examination 1findings 1are 1unremarkable.
What 1visible 1skin 1change 1of 1thebreast 1does 1she 1have?
A) Nipple 1retraction
B) Paget's 1disease
C) Peau 1d'orange 1sign
Ans: 1B
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Feedback: This uncommon form of breast cancer starts as an eczema-like, scaly skin change
around the areola. The lesion may weep, crust, or erode. It can be associated with an underlying
mass, but the skin change can also be found alone. Any eczema-like area around the nipple that
does not respond to topical treatment needs to be evaluated for breast cancer.
3. A 156-year-old 1female 1comes 1to 1your 1clinic, 1complaining 1of 1her 1left 1breast 1looking
1unusual. 1She 1says 1that 1for 12 1months 1theangle 1of 1thenipple 1has 1changed 1direction. 1She 1does
1not 1do 1self- 1examinations, 1so 1she 1doesn't 1know 1if 1she 1has 1a 1lump. 1She 1has 1no 1history 1of
1weight 1loss, 1weight 1gain, 1fever, 1or 1night 1sweats. 1Her 1past 1medical 1history 1is 1significant 1for
1high 1blood 1pressure. 1She 1smokes 1two 1packs 1of 1cigarettes 1a 1day 1and 1has 1three 1to 1four 1drinks
1per 1weekend 1night. 1Her 1paternal 1aunt 1died 1of 1breast 1cancer 1in 1her 1forties. 1Her 1mother 1is
1healthy 1but 1her 1father 1died 1of 1prostate 1cancer. 1On 1examination 1you 1find 1a 1middle-aged
1woman 1appearing 1older 1than 1her 1stated 1age. 1Inspection 1of 1her 1left 1breast 1reveals 1a 1flattened
1nipple 1deviating 1toward 1thelateral 1side. 1On 1palpation 1thenipple 1feels 1thickened. 1Lateral 1to
1theareola 1you 1palpate 1a 1nontender 14-cm 1mass. 1theaxilla 1contains 1several 1fixed 1nodes. 1theright
1breast 1and 1axilla 1examinations 1are 1 unremarkable.
What 1visible 1skin 1change 1of 1thebreast 1does 1she 1have?
A) Nipple 1retraction
B) Paget's 1disease
C) Peau 1d'orange 1sign
Ans: 1A
Feedback: 1A 1retracted 1nipple 1is 1flattened 1or 1pulled 1inward 1or 1toward 1themedial, 1lateral,
1anterior, 1or 1posterior 1side 1of 1thebreast. 1thesurrounding 1skin 1can 1be 1thickened. 1This 1is 1a
1relatively 1late 1finding 1in 1breast 1cancer.
4. A 119-year-old 1female 1comes 1to 1your 1office, 1complaining 1of 1a 1clear 1discharge 1from 1her
1right 1breast 1for 12 1months. 1She 1states 1that 1she 1noticed 1it 1when 1she 1and 1her 1boyfriend 1were
1―messing 1around‖ 1and 1he 1squeezed 1her 1nipple. 1She 1continues 1to 1have 1this 1discharge 1anytime
1she 1squeezes 1that 1nipple. 1She 1denies 1any 1trauma 1to 1her 1breasts. 1Her 1past 1medical 1history 1is
1unremarkable. 1She 1denies 1any 1pregnancies. 1Both 1of 1her 1parents 1are 1healthy. 1She 1denies 1using
1tobacco 1or 1illegal 1drugs 1and 1drinks 1three 1to 1four 1beers 1a 1week. 1On 1examination 1her 1breasts
1are 1symmetric 1with 1no 1skin 1changes. 1You 1are 1able 1to 1express 1clear 1discharge 1from 1her 1right
1nipple. 1You 1feel 1no 1discrete 1masses 1and 1her 1axillae 1are 1normal. 1theremainder 1of 1her 1heart,
1lung, 1abdominal, 1and 1pelvic 1examinations 1are 1unremarkable. 1A 1urine 1pregnancy 1test 1is
1negative.
What 1cause 1of 1nipple 1discharge 1is 1themost 1likely 1in 1her 1circumstance?
A) Benign 1breast 1abnormality
B) Breast 1cancer
C) Nonpuerperal 1galactorrhea
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Ans: A
Feedback: Nipple discharge in benign breast abnormalities tends to be clear and unilateral. The
discharge is usually not spontaneous. This patient needs to be told to stop compressing her
nipple. 1If 1theproblem 1still 1persists 1after 1thepatient 1has 1stopped 1compressing 1thenipple, 1further
1workup 1is 1warranted.
5. A 123-year-old 1computer 1programmer 1comes 1to 1your 1office 1for 1an 1annual 1examination. 1She
1has 1recently 1become 1sexually 1active 1and 1wants 1to 1be 1placed 1on 1birth 1control. 1Her 1only
1complaint 1is 1that 1theskin 1in 1her 1armpits 1has 1become 1darker. 1She 1states 1it 1looks 1like 1dirt, 1and
1she 1scrubs 1her 1 skin 1nightly 1with 1soap 1and 1water 1but 1thecolor 1stays. 1Her 1past 1medical
1symptoms 1consist 1of 1acne 1and 1mild 1obesity. 1Her 1periods 1have 1been 1irregular 1for 13 1years. 1Her
1mother 1has 1type 12 1diabetes 1and 1her 1father 1has 1high 1blood 1pressure. 1thepatient 1denies 1using
1tobacco 1but 1has 1four 1to 1five 1drinks 1on 1Friday 1and 1Saturday 1nights. 1She 1denies 1any 1illegal 1drug
1use. 1On 1examination 1you 1see 1a 1mildly 1obese 1female 1who 1is 1breathing 1comfortably. 1Her 1vital
1signs 1are 1unremarkable. 1Looking 1under 1her 1axilla, 1you 1see 1dark, 1velvet-like 1skin. 1Her 1annual
1examination 1is 1otherwise 1unremarkable.
What 1disorder 1of 1thebreast 1or 1axilla 1is 1she 1most 1likely 1to 1have?
A) Peau 1d'orange
B) Acanthosis 1nigricans
C) Hidradenitis 1suppurativa
Ans: 1B
Feedback: 1Acanthosis 1nigricans 1can 1be 1associated 1with 1an 1internal 1malignancy, 1but 1in 1most
1cases 1it 1is 1a 1benign 1dermatologic 1condition 1associated 1with 1polycystic 1ovarian 1syndrome,
1consisting 1of 1acne, 1hirsutism, 1obesity, 1irregular 1periods, 1infertility, 1ovarian 1cysts, 1and 1early
1onset 1type 12 1diabetes. 1 It 1is 1also 1known 1to 1correlate 1with 1insulin 1resistance.
6. A 143-year-old 1store 1clerk 1comes 1to 1your 1office 1upset 1because 1she 1has 1found 1an 1enlarged
1lymph 1node 1under 1her 1left 1arm. 1She 1states 1she 1found 1it 1yesterday 1when 1she 1was 1feeling 1pain
1under 1her 1arm 1during 1movement. 1She 1states 1thelymph 1node 1is 1about 1an 1inch 1long 1and 1is 1very
1painful. 1She 1checks 1her 1breasts 1monthly 1and 1gets 1a 1yearly 1mammogram 1(her 1last 1was 12
1months 1ago), 1and 1until 1now 1everything 1has 1been 1normal. 1She 1states 1she 1is 1so 1upset 1because
1her 1mother 1died 1in 1her 150s 1of 1breast 1cancer. 1thepatient 1does 1not 1smoke, 1drink, 1or 1use 1illegal
1drugs. 1Her 1father 1is 1in 1good 1health. 1On 1examination 1you 1see 1a 1tense 1female 1appearing 1her
1stated 1age. 1On 1visual 1inspection 1of 1her 1left 1axilla 1you 1see 1a 1tense 1red 1area. 1There 1is 1no
1scarring 1around 1theaxilla. 1Palpating 1this 1area, 1you 1feel 1a 12-cm 1tender, 1movable 1lymph 1node
1underlying 1hot 1skin. 1Other 1shotty 1nodes 1are 1also 1in 1thearea. 1Visualization 1of 1both 1breasts 1is
1normal. 1Palpation 1of 1her 1right 1axilla 1and 1both 1breasts 1is 1unremarkable. 1Examining 1her 1left
1arm, 1you 1see 1a 1scabbed-over
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
superficial laceration over her left hand. Upon your questioning, she remembers she cut her hand
gardening last week.
What disorder of the axilla is most likely responsible for her symptoms?
A) Breast cancer
B) Lymphadenopathy of infectious origin
C) 1Hidradenitis 1suppurativa
Ans: 1B
Feedback: 1A 1lymph 1node 1enlarged 1because 1of 1infection 1is 1generally 1hot, 1tender, 1and 1red. 1Close
1examination 1of 1theskin 1that 1drains 1to 1that 1lymph 1node 1region 1is 1advised. 1Often 1there 1will 1be 1a
1cut 1or 1scratch 1over 1theinvolved 1arm 1that 1has 1an 1infectious 1agent. 1An 1example 1is 1cat 1scratch
1disease.
7. A 163-year-old 1nurse 1comes 1to 1your 1office, 1upset 1because 1she 1has 1found 1an 1enlarged 1lymph
1node 1under 1her 1right 1arm. 1She 1states 1she 1found 1it 1last 1week 1while 1taking 1a 1shower. 1She 1isn't
1sure 1if 1she 1has 1any 1breast 1lumps 1because 1she 1doesn't 1know 1how 1to 1do 1self-exams. 1She 1states
1her 1last 1mammogram 1was 15 1years 1ago 1and 1it 1was 1normal. 1Her 1past 1medical 1history 1is
1significant 1for 1high 1blood 1pressure 1and 1chronic 1obstructive 1pulmonary 1disease. 1She 1quit
1smoking 12 1years 1ago 1after 1a 155-packs/year 1history. 1She 1denies 1using 1any 1illegal 1drugs 1and
1drinks 1alcohol 1rarely. 1Her 1mother 1died 1of 1a 1heart 1attack 1and 1her 1father 1died 1of 1a 1stroke. 1She
1has 1no 1children. 1On 1examination 1you 1see 1an 1older 1female 1appearing 1her 1stated 1age. 1On 1visual
1inspection 1of 1her 1right 1axilla 1you 1see 1nothing 1unusual. 1Palpating 1this 1area, 1you 1feel 1a 12-cm
1hard, 1fixed 1lymph 1node. 1She 1denies 1any 1tenderness. 1Visualization 1of 1both 1breasts 1is 1normal.
1Palpation 1of 1her 1left 1axilla 1and 1breast 1is 1unremarkable. 1On 1palpation 1of 1her 1right 1breast 1you
1feel 1a 1nontender 11-cm 1lump 1in 1thetail 1of 1Spence.
What 1disorder 1of 1theaxilla 1is 1most 1likely 1responsible 1for 1her 1symptoms?
A) Breast 1cancer
B) Lymphadenopathy 1of 1infectious 1origin
C) Hidradenitis 1suppurativa
Ans: 1A
Feedback: 1Metastatic 1lymph 1nodes 1tend 1to 1be 1hard, 1nontender, 1and 1fixed, 1often 1to 1therib 1cage.
1Although 1thepatient 1has 1no 1family 1history 1of 1breast 1cancer, 1she 1is 1at 1a 1slightly 1increased 1risk
1due 1to 1her 1never 1having 1had 1children.
8. A 140-year-old 1mother 1of 1two 1presents 1to 1your 1office 1for 1consultation. 1She 1is 1interested 1in
1knowing 1what 1her 1relative 1risks 1are 1for 1developing 1breast 1cancer. 1She 1is 1concerned 1because
1her 1sister 1had 1unilateral 1breast 1cancer 16 1years 1ago 1at 1age 138. 1thepatient 1reports 1on 1her 1history
1that 1she 1began 1having 1periods 1at 1age 111 1and 1has 1been 1fairly 1regular 1ever 1since, 1except 1during
1her 1two
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superficial laceration over her left hand. Upon your questioning, she remembers she cut her hand
gardening last week.
What disorder of the axilla is most likely responsible for her symptoms?
A) Breast cancer
B) Lymphadenopathy of infectious origin
cancer?
A) First-degree 1relative 1with 1premenopausal 1breast 1cancer
B) Age 1at 1menarche 1of 1less 1than 112
C) First 1live 1birth 1between 1theages 1of 125 1and 129
D) First-degree 1relative 1with 1postmenopausal 1breast 1cancer
Ans: 1A
Feedback: 1Having 1a 1first-degree 1relative 1with 1cancer 1before 1menopause 1gives 1a 1relative 1risk 1of
13.1.
9. A 151-year-old 1cook 1comes 1to 1your 1office 1for 1consultation. 1She 1recently 1found 1out 1that 1her
144- 1year-old 1sister 1with 1premenopausal 1breast 1cancer 1is 1positive 1for 1theBRCA1 1gene. 1Your
1patient 1has 1been 1doing 1research 1on 1theInternet 1and 1saw 1that 1her 1chance 1of 1having 1also
1inherited 1theBRCA1 1gene 1is 150%. 1She 1is 1interested 1in 1knowing 1what 1her 1risk 1of 1developing
1breast 1cancer 1would 1be 1if 1she 1were 1positive 1for 1thegene. 1She 1denies 1any 1lumps 1in 1her 1breasts
1and 1has 1had 1normal 1mammograms. 1She 1has 1had 1no 1weight 1loss, 1fever, 1or 1night 1sweats. 1Her
1mother 1is 1healthy 1and 1her 1father 1has 1prostate 1cancer. 1Two 1of 1her 1paternal 1aunts 1died 1of 1breast
1cancer. 1She 1is 1married. 1She 1denies 1using 1tobacco 1or 1illegal 1drugs 1and 1rarely 1drinks 1alcohol.
1Her 1breast 1and 1axilla 1examinations 1are 1unremarkable.
At 1her 1age, 1what 1is 1her 1risk 1of 1getting 1breast 1cancer 1if 1she 1has 1theBRCA1 1gene?A)
110%
B) 50%
C) 80%
Ans: 1B
Feedback: 1 At 1theage 1of 150, 1therisk 1of 1breast 1cancer 1for 1someone 1with 1theBRCA1 1gene 1is 150%.
10. A 114-year-old 1junior 1high 1school 1student 1is 1brought 1in 1by 1his 1mother 1and 1father 1because
1he 1seems 1to 1be 1developing 1breasts. 1themother 1is 1upset 1because 1she 1read 1on 1theInternet 1that
1smoking 1marijuana 1leads 1to 1breast 1enlargement 1in 1males. 1theyoung 1man 1adamantly 1denies
1usingany 1tobacco, 1alcohol, 1or 1drugs. 1He 1has 1recently 1noticed 1changes 1in 1his 1penis, 1testicles,
1and 1pubic 1hair 1pattern. 1Otherwise, 1his 1past 1medical 1history 1is 1unremarkable. 1His 1parents 1are
1both 1in 1good 1health. 1He 1has 1two 1older 1brothers 1who 1never 1had 1this 1problem. 1On 1examination
1you 1see 1a 1mildly 1overweight 1teenager 1with 1enlarged 1breast 1tissue 1that 1is 1slightly 1tender 1on
1both 1sides. 1Otherwise 1his 1examination 1is 1normal. 1He 1is 1agreeable 1to 1taking 1a 1drug 1test.
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What is the most likely cause of his gynecomastia?
A) Breast cancer
B) Imbalance of hormones of puberty
C) Drug use
Ans: 1B
Feedback: 1Approximately 1one 1third 1of 1teenage 1boys 1develop 1gynecomastia 1during 1puberty. 1It
1is 1not 1surprising 1that 1thetwo 1older 1brothers 1did 1not 1have 1this.
11. A 1patient 1is 1concerned 1about 1a 1dark 1skin 1lesion 1on 1her 1anterolateral 1abdomen. 1It 1has 1not
1changed, 1and 1there 1is 1no 1discharge 1or 1bleeding. 1On 1examination 1there 1is 1a 1medium 1brown
1circular 1lesion 1on 1theanterolateral 1wall 1of 1theabdomen. 1It 1is 1soft, 1has 1regular 1borders, 1is
1evenly 1pigmented, 1and 1is 1about 17 1mm 1in 1diameter. 1What 1is 1this 1lesion?
A) Melanoma
B) Dysplastic 1nevus
C) Supernumerary 1nipple
D) Dermatofibroma
Ans: 1C
Feedback: 1This 1represents 1a 1supernumerary 1nipple. 1These 1occur 1along 1the―milk 1line‖ 1and 1do
1not 1exhibit 1features 1of 1more 1concerning 1lesions.
12. A 130-year-old 1man 1notices 1a 1firm, 12-cm 1mass 1under 1his 1areola. 1He 1has 1no 1other
1symptoms 1and 1no 1diagnosis 1of 1breast 1cancer 1in 1his 1first-degree 1relatives. 1 What 1is 1themost
1likely 1diagnosis?
A) Breast 1tissue
B) Fibrocystic 1disease
C) Breast 1cancer
D) Lymph 1node
Ans: 1A
Feedback: 1Approximately 1one 1third 1of 1adult 1men 1will 1have 1palpable 1breast 1tissue 1under
1theareola. 1 While 1males 1can 1have 1breast 1cancer, 1this 1is 1much 1less 1common. 1 There 1are 1no
1lymph 1nodes 1in 1this 1area.
13. Which 1of 1thefollowing 1lymph 1node 1groups 1is 1most 1commonly 1involved 1in 1breast 1cancer?
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A) Lateral
B) Subscapular
C) Pectoral
D) Central
Ans: 1D
Feedback: 1thecentral 1nodes 1at 1theapex 1of 1theaxilla 1are 1most 1commonly 1involved 1in 1breast 1cancer.
1theaxilla 1can 1be 1viewed 1roughly 1as 1a 1four-sided 1pyramid. 1An 1examination 1covering 1allsides 1and
1theapex 1is 1unlikely 1to 1miss 1a 1significant 1node.
14. When 1should 1a 1woman 1conduct 1breast 1self-examination 1with 1respect 1to 1her 1menses?
A) Five 1to 1seven 1days 1following 1her 1menses
B) Midcycle
C) Immediately 1prior 1to 1menses
D) During 1her 1menses
Ans: 1A
Feedback: 1thebreast 1examination 1should 1be 1conducted 1during 1thetime 1with 1theleast 1estrogen
1stimulation 1of 1thebreast 1tissue. 1This 1corresponds 1to 1five 1to 1seven 1days 1following 1menses.
15. Mrs. 1Patton, 1a 148-year-old 1woman, 1comes 1to 1your 1office 1with 1a 1complaint 1of 1a 1breast
1mass. 1Without 1any 1other 1information, 1what 1is 1therisk 1of 1this 1mass 1being 1cancerous?
A) About 110%
B) About 120%
C) About 130%
D) About 140%
Ans: 1A
Feedback: 1Eleven 1percent 1of 1women 1presenting 1with 1a 1breast 1mass 1will 1have 1breast 1cancer.
1This 1statistic 1can 1be 1reassuring 1to 1a 1patient, 1but 1theimportance 1of 1further 1studies 1must 1be
1emphasized.
16. How 1often, 1according 1to 1American 1Cancer 1Society 1recommendations, 1should 1a
1woman 1undergo 1a 1screening 1breast 1examination 1by 1a 1skilled 1clinician?
A) Every 1year
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B) Every 2 years
C) Every 3 years
D) Every 4 years
Ans: C
Feedback: 1 t 1h 1e 1current 1recommendation 1for 1screening 1by 1breast 1examination 1is 1every 13 1years.
17. Which 1of 1thefollowing 1is 1most 1likely 1benign 1on 1breast 1examination?
A) Dimpling 1of 1theskin 1resembling 1that 1of 1an 1orange
B) One 1breast 1larger 1than 1theother
C) One 1nipple 1inverted
D) One 1breast 1with 1dimple 1when 1thepatient 1leans 1forward
Ans: 1B
Feedback: 1Asymmetry 1in 1size 1of 1thebreasts 1is 1a 1common 1benign 1finding. 1theothers
1areconcerning 1for 1underlying 1malignancy.
18. Which 1is 1themost 1effective 1pattern 1of 1palpation 1for 1breast 1cancer?
A) Beginning 1at 1thenipple, 1make 1an 1ever-enlarging 1spiral.
B) Divide 1thebreast 1into 1quadrants 1and 1inspect 1each 1systematically.
C) Examine 1in 1lines 1resembling 1theback 1and 1forth 1pattern 1of 1mowing 1a 1lawn.
D) Beginning 1at 1thenipple, 1palpate 1outward 1in 1a 1stripe 1pattern.
Ans: 1C
Feedback: 1thevertical 1strip 1pattern 1has 1been 1shown 1to 1be 1themost 1effective 1pattern 1for
1palpation 1of 1thebreast. 1themost 1important 1aspect, 1however, 1is 1to 1be 1systematic. 1thetail
1ofSpence, 1located 1on 1theupper 1anterior 1chest, 1is 1an 1area 1commonly 1missed 1on 1examination.
19. Which 1is 1true 1of 1women 1who 1have 1had 1a 1unilateral 1mastectomy?
A) They 1no 1longer 1require 1breast 1examination.
B) They 1should 1be 1examined 1carefully 1along 1thesurgical 1scar 1for 1masses.
C) Lymphedema 1of 1theipsilateral 1arm 1usually 1suggests 1recurrence 1of 1breast 1cancer.
D) Women 1with 1breast 1reconstruction 1over 1their 1mastectomy 1site 1no 1longer 1require 1examination.
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Ans: B
Feedback: A woman who has had breast cancer remains at high risk for recurrence, especially in
the contralateral breast. The mastectomy site should be carefully examined for local recurrence
as well. Lymphedema or swelling of the ipsilateral arm following mastectomy is common and
does 1not 1usually 1indicate 1recurrence. 1Women 1with 1breast 1reconstruction 1must 1also 1undergo
1careful 1examination.
20. Which 1of 1thefollowing 1is 1true 1regarding 1breast 1self-examination?
A) It 1has 1been 1shown 1to 1reduce 1mortality 1from 1breast 1cancer.
B) It 1is 1recommended 1unanimously 1by 1organizations 1making 1screening 1recommendations.
C) A 1high 1proportion 1of 1breast 1masses 1are 1detected 1by 1breast 1self-examination.
D) The 1undue 1fear 1caused 1by 1finding 1a 1mass 1justifies 1omitting 1instruction 1in 1breast
1self- 1examination.
Ans: 1C
Feedback: 1Although 1self-examination 1has 1not 1been 1shown 1to 1reduce 1mortality 1and 1is 1not
1recommended 1by 1all 1groups 1making 1screening 1recommendations, 1many 1choose 1to 1teach 1women 1a
1systematic 1method 1in 1which 1to 1examine 1their 1breasts. 1A 1high 1proportion 1of 1breast 1masses 1are
1detected 1by 1breast 1self-examination.
Chapter 1 18 1theMusculoskeletal 1 SystemMultiple
Choice
1. You 1are 1assessing 1a 1patient 1with 1joint 1pain 1and 1are 1trying 1to 1decide 1whether 1it 1is
1inflammatory 1or 1noninflammatory 1in 1nature. 1Which 1one 1of 1thefollowing 1symptoms 1is
1consistent 1with 1an 1inflammatory 1process?
A) Tenderness
B) Cool 1temperature
C) Ecchymosis
D) Nodules
Ans: 1A
Feedback: 1Tenderness 1implies 1an 1inflammatory 1process 1along 1with 1increased 1temperature 1and
1tenderness.
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2. You are assessing a patient with diffuse joint pains and want to make sure that only the joints
are 1theproblem, 1and 1that 1thepain 1is 1not 1related 1to 1other 1diseases. 1Which 1of 1thefollowing 1is 1a
1systemic 1cause 1of 1joint 1pain?
A) Gout
B) Osteoarthritis
C) Lupus
D) Spondylosis
Ans: 1C
Feedback: 1Lupus 1is 1a 1systemic 1disease, 1one 1symptom 1of 1which 1may 1be 1joint 1pain. 1It 1is
1important 1to 1consider 1thepresence 1of 1a 1systemic 1illness 1when 1a 1patient 1presents 1with 1arthritis.
3. A 119-year-old 1college 1sophomore 1comes 1to 1theclinic 1for 1evaluation 1of 1joint 1pains.
1thestudent 1has 1been 1back 1from 1spring 1break 1for 12 1weeks; 1during 1her 1holiday, 1she 1went
1camping. 1Shenotes 1that 1she 1had 1a 1red 1spot, 1shaped 1like 1a 1target, 1but 1then 1it 1started 1spreading,
1and 1then 1thejointpains 1started. 1She 1used 1insect 1repellant 1but 1was 1in 1an 1area 1known 1to 1have
1ticks. 1She 1has 1never 1been 1sick 1and 1takes 1no 1medications 1routinely; 1she 1has 1never 1been
1sexually 1active. 1What 1is 1themost 1likely 1cause 1of 1her 1joint 1pain?
A) Trauma
B) Gonococcal 1arthritis
C) Psoriatic 1arthritis
D) Lyme 1disease
Ans: 1D
Feedback: 1Lyme 1disease 1is 1characterized 1by 1a 1target-shaped 1red 1spot 1at 1thesite 1of 1thebite,
1which 1disappears, 1then 1reappears 1and 1starts 1spreading 1(erythema 1migrans). 1Lyme 1disease 1can
1also 1result 1in 1joint 1pain 1as 1well 1as 1cardiac 1and 1neurologic 1manifestations.
4. An 185-year-old 1retired 1housewife 1comes 1with 1her 1daughter 1to 1establish 1care. 1Her 1daughter
1is 1concerned 1because 1her 1mother 1has 1started 1to 1fall 1more. 1As 1part 1of 1her 1physical 1examination,
1you 1ask 1her 1to 1walk 1across 1theexamination 1room. 1Which 1of 1thefollowing 1is 1not 1part 1of
1thestance 1phase 1of 1gait?
A) Foot 1arched
B) Heel 1strike
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C) Mid-stance
D) Push-off
Ans: A
Feedback: 1thefoot 1when 1it 1is 1flat 1is 1part 1of 1thestance 1phase 1of 1gait, 1not 1thefoot 1when 1it 1is
1arched.
5. A 132-year-old 1warehouse 1worker 1presents 1for 1evaluation 1of 1low 1back 1pain. 1He 1notes 1a
1sudden 1onset 1of 1pain 1after 1lifting 1a 1set 1of 1boxes 1that 1were 1heavier 1than 1usual. 1He 1also 1states
1that 1he 1has 1numbness 1and 1tingling 1in 1theleft 1leg. 1He 1wants 1to 1know 1if 1he 1needs 1to 1be 1off 1of
1work. 1What 1test 1should 1you 1perform 1to 1assess 1for 1a 1herniated 1disc?
A) Leg-length 1test
B) Straight-leg 1raise
C) Tinel's 1test
D) Phalen's 1test
Ans: 1B
Feedback: 1thestraight-leg 1raise 1involves 1having 1thepatient 1lie 1supine 1with 1theexaminer
1raising 1theleg. 1If 1thepatient 1experiences 1a 1sharp 1pain 1radiating 1from 1theback 1down 1theleg 1in 1an
1L5 1or 1S1 1distribution, 1that 1suggests 1thepresence 1of 1a 1herniated 1disc.
6. A 133-year-old 1construction 1worker 1comes 1for 1evaluation 1and 1treatment 1of 1acute 1onset 1of
1low 1back 1pain. 1He 1notes 1that 1thepain 1is 1an 1aching 1located 1in 1thelumbosacral 1area. 1It 1has 1been
1present 1intermittently 1for 1several 1years; 1there 1is 1no 1known 1trauma 1or 1injury. 1He 1points 1to
1theleft 1lower 1back. 1thepain 1does 1not 1radiate 1and 1there 1is 1no 1numbness 1or 1tingling 1in 1thelegs
1or 1incontinence. 1He 1was 1moving 1furniture 1for 1a 1friend 1over 1theweekend. 1On 1physical
1examination, 1you 1note 1muscle 1spasm, 1with 1normal 1deep 1tendon 1reflexes 1and 1muscle 1strength.
1What 1is 1themost 1likely 1cause 1of 1this 1patient's 1low 1back 1pain?
A) Herniated 1disc
B) Compression 1fracture
C) Mechanical 1low 1back 1pain
D) Ankylosing 1spondylitis
Ans: 1C
Feedback: 1thecase 1is 1an 1example 1of 1mechanical 1low 1back 1pain; 1in 1a 1large 1percentage 1of 1cases
1there 1is 1no 1known 1underlying 1cause. 1thepain 1is 1often 1precipitated 1by 1moving, 1lifting, 1or
1twisting 1motions 1and 1relieved 1by 1rest.
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7. A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor
vehicle 1collision 12 1days 1ago 1and 1was 1assessed 1by 1theemergency 1medical 1technicians 1on 1site,
1but 1she 1didn't 1think 1that 1she 1needed 1to 1go 1to 1theemergency 1room 1at 1that 1time. 1Now, 1she 1has
1severe 1pain 1and 1stiffness 1in 1her 1neck. 1On 1physical 1examination, 1you 1note 1pain 1and 1spasm 1over
1theparaspinous 1muscles 1on 1theleft 1side 1of 1theneck, 1and 1pain 1when 1you 1make 1thepatient 1do
1active 1range 1of 1motion 1of 1thecervical 1spine. 1What 1is 1themost 1likely 1cause 1of 1this 1neck 1pain?
A) Simple 1stiff 1neck
B) Aching 1neck
C) Cervical 1sprain
D) Cervical 1herniated 1disc
Ans: 1C
Feedback: 1thepatient 1most 1likely 1has 1an 1acute 1whiplash 1injury 1secondary 1to 1thecollision.
1thefeatures 1of 1thephysical 1examination, 1local 1tenderness 1and 1pain 1on 1movement, 1are 1consistent
1withcervical 1sprain.
8. A 128-year-old 1graduate 1student 1comes 1to 1your 1clinic 1for 1evaluation 1of 1pain 1―all 1over.‖
1With 1further 1questioning, 1she 1is 1able 1to 1relate 1that 1thepain 1is 1worse 1in 1theneck, 1shoulders,
1hands, 1low 1back, 1and 1knees. 1She 1denies 1swelling 1in 1her 1joints; 1she 1states 1that 1thepain 1is
1worse 1in 1themorning; 1there 1is 1no 1limitation 1in 1her 1range 1of 1motion. 1On 1physical 1examination,
1she 1has 1severalpoints 1on 1themuscles 1of 1theneck, 1shoulders, 1and 1back 1that 1are 1tender 1to
1palpation; 1muscle 1strength 1and 1range 1of 1motion 1are 1normal. 1Which 1of 1thefollowing 1is 1likely
1thecause 1of 1her 1pain?
A) Rheumatoid 1arthritis
B) Osteoarthritis
C) Fibromyalgia
D) Polymyalgia 1rheumatica
Ans: 1C
Feedback: 1 t 1h 1e 1patient 1has 1pain 1in 1specific 1trigger 1point 1areas 1on 1themuscles, 1with 1normal
1strength 1and 1range 1of 1motion. 1This 1is 1an 1indication 1for 1fibromyalgia.
9. A 168-year-old 1retired 1banker 1comes 1to 1your 1clinic 1for 1evaluation 1of 1left 1shoulder 1pain. 1He
1swims 1for 130 1minutes 1daily, 1early 1in 1themorning. 1He 1notes 1a 1sharp, 1catching 1pain 1and 1a
1sensation 1of 1something 1grating 1when 1he 1tries 1overhead 1movements 1of 1his 1arm. 1On 1physical
1examination,
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you note tenderness just below the tip of the acromion in the area of the tendon insertions. The
drop arm test is negative, and there is no limitation with shoulder shrug. The patient is not
holding his arm close to his side, and there is no tenderness to palpation in the bicipital groove
when the arm is at the patient's side, flexed to 90 degrees, and then supinated against resistance.
Based on this description, what is the most likely cause of his shoulder pain?
A) Rotator 1cuff 1tendinitis
B) Rotator 1cuff 1tear
C) Calcific 1tendinitis
D) Bicipital 1tendinitis
Ans: 1A
=
Feedback: 1Rotator 1cuff 1tendinitis 1is 1typically 1precipitated 1by 1repetitive 1motions, 1such 1as 1occurs
1with 1throwing 1or 1swimming. 1Crepitus/grating 1is 1noted 1in 1theshoulder 1with 1range 1of 1motion.
10. A 1high 1school 1soccer 1player 1―blew 1out 1his 1knee‖ 1when 1theopposing 1goalie's 1head
1and 1shoulder 1struck 1his 1flexed 1knee 1while 1thegoalie 1was 1diving 1for 1theball. 1All 1of
1thefollowing 1structures 1were 1involved 1in 1some 1way 1in 1his 1injury, 1but 1which 1of
1thefollowing 1is 1actually 1an 1extra-articular 1structure?
A) Synovium
B) Joint 1capsule
C) Juxta-articular 1bone
D) Tendons
Ans: 1D
Feedback: 1Extra-articular 1structures 1include 1theperiarticular 1ligaments, 1tendons, 1bursae, 1muscle,
1fascia, 1bone, 1nerve, 1and 1overlying 1skin. 1thearticular 1structures 1include 1thejoint 1capsule 1and
1articular 1cartilage, 1thesynovium 1and 1synovial 1fluid, 1intra-articular 1ligaments, 1and 1juxtaarticular 1bone.
11. Ray 1works 1a 1physical 1job 1and 1notes 1pain 1when 1he 1attempts 1to 1lift 1his 1arm 1over 1his 1head.
1When 1you 1move 1theshoulder 1passively, 1he 1has 1full 1range 1of 1motion 1without 1pain 1and 1there 1is
1no 1gross 1swelling 1or 1tenderness. 1 What 1type 1of 1joint 1disease 1does 1this 1most 1likely 1represent?
A) Articular
B) Extra-articular
C) Neither
D) Both
Ans: 1B
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Feedback: This description fits extra-articular disease. Articular disease typically involves
swelling and tenderness of the entire joint and limits both active and passive range of motion.
This is most likely extra-articular because it affects a certain portion of the range of motion, is
not painful with passive range of motion, and is not associated with gross swelling or tenderness
12. Mark 1is 1a 1contractor 1who 1recently 1injured 1his 1back. 1He 1was 1told 1he 1had 1a 1―bulging 1disc‖
1to 1account 1for 1theburning 1pain 1down 1his 1right 1leg 1and 1slight 1foot 1drop. 1thevertebral 1bodies
1of 1thespine 1involve 1which 1type 1of 1joint?
A) Synovial
B) Cartilaginous
C) Fibrous
D) Synostosis
Ans: 1B
Feedback: 1thevertebral 1bodies 1of 1thespine 1are 1connected 1by 1cartilaginous 1joints 1involving 1thediscs.
1theelbow 1would 1be 1an 1example 1of 1a 1synovial 1joint, 1and 1thesutures 1of 1theskull 1are 1an 1example 1of
1a 1fibrous 1joint.
13. Which 1of 1thefollowing 1synovial 1joints 1would 1be 1an 1example 1of 1a 1condylar 1joint?
A) Hip
B) Interphalangeal 1joints 1of 1thehand
C) Temporomandibular 1joint
D) Intervertebral 1joint
Ans: 1C
Feedback: 1theTMJ 1is 1an 1example 1of 1a 1condylar 1joint 1because 1it 1involves 1themovement 1of 1two
1surfaces 1which 1are 1not 1dissociable. 1thehip 1would 1be 1an 1example 1of 1a 1spheroidal 1joint 1and
1theinterphalangeal 1joints 1of 1thehand 1are 1hinge 1joints. 1theintervertebral 1joints 1are 1not 1synovial
1joints 1at 1all, 1but 1rather 1cartilaginous 1joints.
14. A 158-year-old 1man 1comes 1to 1your 1office 1complaining 1of 1bilateral 1back 1pain 1that 1now
1awakens 1him 1at 1night. 1 This 1has 1been 1steadily 1increasing 1for 1thepast 12 1months. 1 Which 1one
1of 1thefollowing 1is 1themost 1reassuring 1in 1this 1patient 1with 1back 1pain?
A) Age 1over 150
B) Pain 1at 1night
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C) Pain lasting more than 1 month or not responding to therapy
D) Pain that is bilateral
Ans: D
Feedback: 1While 1bilateral 1pain 1can 1be 1associated 1with 1serious 1illness, 1it 1is 1not 1one 1of 1the―red
1flags‖ 1of 1back 1pain. 1Red 1flags 1should 1make 1one 1suspicious 1for 1serious 1underlying 1systemic
1disease 1such 1as 1cancer, 1infection, 1or 1others. 1This 1list 1includes: 1age 1over 150, 1history 1of 1cancer,
1unexplained 1weight 1loss, 1pain 1lasting 1more 1than 11 1month 1or 1not 1responding 1to 1treatment, 1pain
1at 1night 1or 1increased 1by 1rest, 1history 1of 1intravenous 1drug 1use, 1or 1presence 1of 1infection.
1thepresence 1of 1one 1of 1these 1with 1low 1back 1pain 1indicates 1a 110% 1probability 1of 1a 1serious
1systemic 1disease.
15. Marion 1presents 1to 1your 1office 1with 1back 1pain 1associated 1with 1constipation 1and
1urinary 1retention. 1 Which 1of 1thefollowing 1is 1most 1likely?
A) Sciatica
B) Epidural 1abscess
C) Cauda 1equina
D) Idiopathic 1low 1back 1pain
Ans: 1C
Feedback: 1thepresence 1of 1bowel 1and 1bladder 1symptoms 1associated 1with 1back 1pain 1is
1worrisome 1and 1should 1suggest 1impingement 1of 1nerve 1roots 1S2–S4. 1For 1this 1reason 1idiopathic
1low 1back 1pain 1is 1unlikely. 1Epidural 1abscess 1may 1present 1with 1midline 1pain 1which 1can 1be
1increased 1with 1percussion 1over 1thespinous 1processes. 1Sciatica 1is 1associated 1with 1pain 1which
1radiates 1into 1thebuttocks 1and/or 1down 1theposterior 1leg 1in 1theS1 1distribution.
16. Louise, 1a 160-year-old, 1complains 1of 1left 1knee 1pain 1associated 1with 1tenderness
1throughout, 1redness, 1and 1warmth 1over 1thejoint. 1Which 1of 1thefollowing 1is 1least 1helpful 1in
1determining 1if 1a 1joint 1problem 1is 1inflammatory?
A) Tenderness
B) Pain
C) Warmth
D) Redness
Ans: 1B
Feedback: 1Pain 1is 1present 1in 1both 1inflammatory 1and 1noninflammatory 1conditions. 1Warmth,
1redness, 1and 1tenderness 1to 1palpation 1should 1lead 1one 1to 1consider 1an 1inflammatory 1etiology 1for
1the
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pain.
17. Pain, 1swelling, 1loss 1of 1both 1active 1and 1passive 1motion, 1locking, 1and 1deformity 1would
1be 1consistent 1with 1which 1of 1thefollowing?
A) Articular 1joint 1pain
B) Bursitis
C) Muscular 1injury
D) Nerve 1damage
Ans: 1A
Feedback: 1These 1features 1are 1consistent 1with 1articular 1joint 1pain, 1whereas 1theother 1problems
1are 1associated 1with 1extra-articular 1structures.
18. You 1are 1working 1in 1a 1college 1health 1clinic 1and 1seeing 1a 1young 1woman 1with 1a 1red,
1painful, 1swollen 1DIP 1joint 1on 1theleft 1index 1finger. 1 There 1are 1also 1a 1few 1papules, 1pustules,
1and 1vesicles 1on 1reddened 1bases, 1located 1on 1thedistal 1extremities. 1This 1would 1be 1consistent
1with 1which 1of 1thefollowing?
A) Lyme 1disease
B) Systemic 1lupus 1erythematosus
C) Hives 1(urticaria)
D) Gonococcal 1arthritis
Ans: 1D
Feedback: 1thepresentation 1of 1a 1monoarthritis 1in 1this 1age 1group 1should 1lead 1one 1to 1think 1of
1gonococcal 1disease. 1Skin 1findings 1are 1often 1seen 1in 1conjunction 1with 1arthritis. 1Lyme 1disease 1is
1associated 1with 1an 1expanding 1erythematous 1patch. 1Lupus 1is 1associated 1with 1a 1―butterfly‖ 1rash 1on
1thecheeks, 1while 1serum 1sickness 1and 1drug 1reactions 1can 1be 1associated 1with 1hives.
19. An 1obese 155-year-old 1woman 1went 1through 1menarche 1at 1age 116 1and 1menopause 12 1years
1ago. 1She 1is 1concerned 1because 1an 1aunt 1had 1severe 1osteoporosis. 1 Which 1of 1thefollowing 1is 1a
1risk 1factor 1for 1osteoporosis?
A) Obesity
B) Late 1menopause
C) Having 1an 1aunt 1with 1osteoporosis
D) Delayed 1menarche
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Ans: D
Feedback: Obesity and late menopause are not associated with osteoporosis. Having a firstdegree relative with osteoporosis is a risk factor, but an aunt is a second-degree relative.
Delayed menarche is the only choice which is a known risk factor for osteoporosis.
20. A 138-year-old 1woman 1comes 1to 1you 1and 1has 1multiple 1small 1joints 1involved 1with
1pain, 1swelling, 1and 1stiffness. 1 Which 1of 1thefollowing 1is 1themost 1likely 1explanation?
A) Rheumatoid 1arthritis
B) Septic 1arthritis
C) Gout
D) Trauma
Ans: 1A
Feedback: 1Rheumatoid 1arthritis 1is 1a 1systemic 1disease 1and 1accounts 1for 1multiple 1symmetrically
1involved 1joints. 1Septic 1arthritis 1is 1usually 1monoarticular, 1as 1are 1gout 1and 1trauma-related 1joint
1pain.
21. Mrs. 1Fletcher 1comes 1to 1your 1office 1with 1unilateral 1pain 1during 1chewing, 1which 1is
1chronic. 1She 1does 1not 1have 1facial 1tenderness 1or 1tenderness 1of 1thescalp. 1Which 1of
1thefollowing 1is 1themost 1likely 1cause 1of 1her 1pain?
A) Trigeminal 1neuralgia
B) Temporomandibular 1joint 1syndrome
C) Temporal 1arteritis
D) Tumor 1of 1themandible
Ans: 1B
Feedback: 1Temporomandibular 1joint 1syndrome 1is 1a 1very 1common 1cause 1of 1pain 1with
1chewing. 1Ischemic 1pain 1with 1chewing, 1or 1jaw 1claudication, 1can 1occur 1with 1temporal 1arteritis,
1but 1thelack 1of 1tenderness 1of 1thescalp 1overlying 1theartery 1makes 1this 1less 1likely. 1Trigeminal
1neuralgia 1can 1be 1associated 1with 1extreme 1tenderness 1over 1thebranches 1of 1thetrigeminal 1nerve.
1 While 1a 1tumorof 1themandible 1is 1possible, 1is 1it 1much 1less 1likely 1than 1theother 1choices.
22. A 1man's 1wife 1is 1upset 1because 1when 1she 1hugs 1him 1with 1her 1hands 1on 1his 1left 1shoulder 1blade,
―it 1feels 1creepy.‖ 1 This 1came 1on 1gradually 1after 1a 1recent 1severe 1left-sided 1rotator 1cuff 1tear. 1 How
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
D) 12–3 1months
Ans: 1B
Feedback: 1Prominence 1of 1thescapular 1spine 1occurs 1with 1generalized 1muscle 1wasting 1as 1well 1as
1with 1specific 1injuries 1such 1as 1a 1rotator 1cuff 1tear. 1It 1is 1easily 1palpable, 1even 1through 1indoor
1clothing, 1although 1theback 1should 1be 1exposed 1to 1make 1other 1important 1observations. 1Atrophy
1usually 1occurs 1several 1weeks 1following 1a 1rotator 1cuff 1tear.
23. Phil 1comes 1to 1your 1office 1with 1left 1―shoulder 1pain.‖ 1You 1find 1that 1thepain 1is
1markedly 1worse 1when 1his 1left 1arm 1is 1drawn 1across 1his 1chest 1(adduction). 1 Which 1of
1thefollowing 1would 1you 1suspect?
A) Rotator 1cuff 1tear
B) Subacromial 1bursitis
C) Acromioclavicular 1joint 1involvement
D) Adhesive 1capsulitis
Ans: 1C
Feedback: 1Adduction 1of 1thepatient's 1arm 1across 1his 1chest 1can 1cause 1pain 1if
1theacromioclavicular 1joint 1is 1involved. 1In 1adhesive 1capsulitis, 1this 1maneuver 1may 1not 1be
1possibledue 1to 1limited 1range 1of 1motion. 1Subacromial 1bursitis 1would 1present 1with
1tenderness 1inferior 1totheacromion. 1Rotator 1cuff 1injury 1would 1ordinarily 1not 1be 1associated 1with
1pain 1during 1this 1maneuver.
24. Two 1weeks 1ago, 1Mary 1started 1a 1job 1which 1requires 1carrying 140-pound 1buckets. 1She
1presents 1with 1elbow 1pain 1worse 1on 1theright. 1On 1examination, 1it 1hurts 1her 1elbows 1to 1dorsiflex
1her 1hands 1against 1resistance 1when 1her 1palms 1face 1thefloor. 1 What 1condition 1does 1she 1have?
A) Medial 1epicondylitis 1(golfer's 1elbow)
B) Olecranon 1bursitis
C) Lateral 1epicondylitis 1(tennis 1elbow)
D) Supracondylar 1fracture
Ans: 1C
Feedback: 1 Mary's 1injury 1probably 1occurred 1by 1lifting 1heavy 1buckets 1with 1her 1palms 1down
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
25. A 1high 1school 1football 1player 1injured 1his 1wrist 1in 1a 1game. 1He 1is 1tender 1between
1thetwo 1tendons 1at 1thebase 1of 1thethumb. 1Which 1of 1thefollowing 1should 1be 1considered?
A) DeQuervain's 1tenosynovitis
B) Scaphoid 1fracture
C) Wrist 1sprain
D) Rheumatoid 1arthritis
Ans: 1B
Feedback: 1the―anatomic 1snuffbox‖ 1is 1found 1between 1theextensor 1and 1abductor 1tendons 1at
1thebase 1of 1thethumb. 1Tenderness 1should 1make 1one 1think 1of 1a 1scaphoid 1fracture. 1Not 1only 1is
1this 1themost 1common 1carpal 1bone 1injury, 1but 1thepoor 1blood 1supply 1puts 1thebone 1at 1risk 1for
1avascular 1necrosis 1when 1injured. 1This 1fracture 1is 1commonly 1missed 1on 1x-ray, 1so 1this 1is 1an
1important 1physical 1finding 1to 1support 1further 1or 1repeated 1studies.
Chapter 119 1Mental 1Status
1Multiple 1Choice
1. A 119-year-old 1college 1student, 1Todd, 1is 1brought 1to 1your 1clinic 1by 1his 1mother. 1She 1is
1concerned 1that 1there 1is 1something 1seriously 1wrong 1with 1him. 1She 1states 1for 1thepast 16 1months
1his 1behavior 1has 1become 1peculiar 1and 1he 1has 1flunked 1out 1of 1college. 1Todd 1denies 1any 1recent
1illness 1or 1injuries. 1His 1past 1medical 1history 1is 1remarkable 1only 1for 1a 1broken 1foot. 1His 1parents
1are 1both 1healthy. 1He 1has 1a 1paternal 1uncle 1who 1had 1similar 1symptoms 1in 1college. 1thepatient
1admits 1to 1smoking 1cigarettes 1and 1drinking 1alcohol. 1He 1also 1admits 1to 1marijuana 1use 1but 1none
1in 1thelast 1week. 1He 1denies 1using 1any 1other 1substances. 1He 1denies 1any 1feelings 1of 1depression 1or
1anxiety. 1While 1speaking 1with 1Todd 1and 1his 1mother 1you 1do 1a 1complete 1physical 1examination,
1which 1is 1essentially 1normal. 1When 1you 1question 1him 1on 1how 1he 1is 1feeling, 1he 1says 1that 1he 1is
1very 1worried 1that 1Microsoft 1has 1stolen 1his 1software 1for 1creating 1a 1better 1browser. 1He 1tells 1you
1he 1has 1seen 1a 1black
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
While 1arranging 1for 1a 1psychiatry 1consult, 1what 1psychotic 1disorder 1do 1you 1think 1Todd 1has?
A) Schizoaffective 1disorder
B) Psychotic 1disorder 1due 1to 1a 1medical 1illness
C) Substance-induced 1psychotic 1disorder
D) Schizophrenia
Ans: 1D
Feedback: 1Schizophrenia 1generally 1occurs 1in 1thelate 1teens 1to 1early 120s. 1It 1often 1is 1seen 1in
1other 1family 1members, 1as 1in 1this 1case. 1Symptoms 1must 1be 1present 1for 1at 1least 16 1months 1and
1must 1have 1at 1least 1two 1features 1of 1(1) 1delusions 1(e.g., 1Microsoft 1is 1after 1his 1programs), 1(2)
1hallucinations 1(e.g., 1technicians 1sending 1telepathic 1signals), 1(3) 1disorganized 1speech, 1(4)
1disorganized 1behavior, 1and 1(5) 1negative 1symptoms 1such 1as 1a 1flat 1affect.
2. A 124-year-old 1secretary 1comes 1to 1your 1clinic, 1complaining 1of 1difficulty 1sleeping, 1severe
1nightmares, 1and 1irritability. 1She 1states 1it 1all 1began 16 1months 1ago 1when 1she 1went 1to 1a 1fast 1food
1restaurant 1at 1midnight. 1While 1she 1was 1waiting 1in 1her 1car 1a 1man 1entered 1through 1thepassenger
1door 1and 1put 1a 1gun 1to 1her 1head. 1He 1had 1her 1drive 1to 1a 1remote 1area, 1where 1he 1took 1her 1money
1and 1threatened 1to 1kill 1her. 1When 1thegun 1jammed 1he 1panicked 1and 1ran 1off. 1Ever 1since 1this
1occurred 1thepatient 1has 1been 1having 1these 1symptoms. 1She 1states 1she 1jumps 1at 1every 1noise 1and
1refuses 1to 1drive 1at 1night. 1She 1states 1her 1anxiety 1has 1had 1such 1a 1marked 1influence 1on 1her 1job
1performance 1she 1is 1afraid 1she 1will 1be 1fired. 1She 1denies 1any 1recent 1illnesses 1or 1injuries. 1Her
1past 1medical 1history 1is 1unremarkable. 1On 1examination 1you 1find 1a 1nervous 1woman 1appearing
1her 1stated 1age. 1Her 1physical 1examination 1is 1unremarkable. 1You 1recommend 1medication 1and
1counseling.
What 1anxiety 1disorder 1to 1you 1think 1this 1young 1woman 1has?
A) Specific 1phobia
B) Acute 1stress 1disorder
C) Post-traumatic 1stress 1disorder
D) Generalized 1anxiety 1disorder
Ans: 1C
Feedback: 1Post-traumatic 1stress 1disorder 1is 1thefearful 1response 1(nightmares, 1avoidance 1of 1areas,
1irritability) 1to 1an 1event 1that 1occurred 1at 1least 11 1month 1prior 1to 1presentation. 1thepatient's 1fears
1and 1reactions 1cause 1marked 1distress 1and 1impair 1social 1and 1occupational 1functions.
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
was 1in 1a 1rehab 1center, 1where 1he 1regained 1theability 1to 1walk 1and 1most 1of 1theuse 1of 1his 1right
1hand. 1He 1also 1began 1to 1speak 1more, 1but 1she 1says 1that 1much 1of 1thetime 1―he 1doesn't 1make
1any 1sense.‖ 1She 1gives 1an 1example 1that 1when 1she 1reminded 1him 1thecar 1needed 1to 1be 1serviced
1he 1told 1her 1―I 1will 1change 1theKool-Aid 1out 1of 1thesink 1myself 1with 1theludrip.‖ 1She 1says 1that
1these 1sayings 1are 1becoming 1frustrating. 1She 1wants 1you 1to 1tell 1her 1what 1is 1wrong 1and 1what
1you 1can 1do 1about 1it.
While 1you 1write 1up 1a 1consult 1to 1neurology, 1you 1describe 1thesyndrome 1to 1her.
1What 1type 1of 1aphasia 1does 1he 1have?
A) Wernicke's 1aphasia
B) Broca's 1aphasia
C) Dysarthria
Ans: 1A
Feedback: 1With 1Wernicke's 1aphasia 1thepatient 1can 1speak 1effortlessly 1and 1fluently, 1but 1his
1words 1often 1make 1no 1sense. 1Words 1can 1be 1malformed 1or 1completely 1invented. 1Wernicke's 1area
1is 1found 1on 1thetemporal 1lobes.
4. A 132-year-old 1white 1female 1comes 1to 1your 1clinic, 1complaining 1of 1overwhelming 1sadness.
1She 1says 1for 1thepast 12 1months 1she 1has 1had 1crying 1episodes, 1difficulty 1sleeping, 1and 1problems
1with 1overeating. 1She 1says 1she 1used 1to 1go 1out 1with 1her 1friends 1from 1work 1but 1now 1she 1just
1wants 1to 1go 1home 1and 1be 1by 1herself. 1She 1also 1thinks 1that 1her 1work 1productivity 1has 1been
1dropping 1because 1she 1just 1is 1too 1tired 1to 1care 1or 1concentrate. 1She 1denies 1any 1feelings 1of 1guilt
1or 1any 1suicidal 1ideation. 1She 1states 1that 1she 1has 1never 1felt 1this 1way 1in 1thepast. 1She 1denies 1any
1recent 1illness 1or 1injuries. 1Her 1past 1medical 1history 1consists 1of 1an 1appendectomy 1when 1she 1was
1a 1teenager; 1otherwise, 1she 1has 1been 1healthy. 1She 1is 1single 1and 1works 1as 1a 1clerk 1in 1a 1medical
1office. 1She 1denies 1tobacco, 1alcohol, 1or 1illegal 1drug 1use. 1Her 1mother 1has 1high 1blood 1pressure
1and 1her 1father 1has 1had 1a 1history 1of 1mental 1illness. 1On 1examination 1you 1see 1a 1woman
1appearing 1her 1stated 1age 1who 1seems 1quite 1sad. 1Her 1facial 1expression 1does 1not 1change 1while
1you 1talk 1to 1her 1and 1she 1makes 1little 1eye 1contact. 1She 1speaks 1so 1softly 1you 1cannot 1always
1understand 1her. 1Her 1thought 1processes 1and 1content 1seem 1unremarkable.
What 1type 1of 1mood 1disorder 1do 1you 1think 1she 1has?
A) Dysthymic 1disorder
B) Manic 1(bipolar) 1disorder
C) Major 1depressive 1episode
Ans: 1C
Feedback: 1Major 1depression 1occurs 1in 1a 1person 1with 1a 1previously 1normal 1state 1of 1mood.
1thesymptoms 1often 1consist 1of 1a 1combination 1of 1sadness, 1decreased 1interest, 1sleeping 1problems
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
5. A 127-year-old 1woman 1is 1brought 1to 1your 1office 1by 1her 1mother. 1themother 1tells 1you 1that 1her
1daughter 1has 1been 1schizophrenic 1for 1thelast 18 1years 1and 1is 1starting 1to 1decompensate 1despite
1medication. 1thepatient 1states 1that 1she 1has 1been 1taking 1her 1antipsychotic 1and 1she 1is 1doing 1just
1fine. 1Her 1mother 1retorts 1that 1her 1daughter 1has 1become 1quite 1paranoid. 1When 1asked 1why,
1themother 1gives 1an 1example 1about 1themailman. 1She 1says 1that 1her 1daughter 1goes 1and 1gets
1themail 1every 1day 1and 1then 1microwaves 1theletters. 1thepatient 1agrees 1that 1she 1does 1this 1but
1only 1becauseshe 1sees 1themailman 1flipping 1through 1theenvelopes 1and 1she 1knows 1he's 1putting
1anthrax 1on 1theletters. 1Her 1mother 1turns 1to 1her 1and 1says, 1―He's 1only 1sorting 1themail!‖
Which 1best 1describes 1thepatient's 1abnormality 1of 1perception?
A) Illusion
B) Hallucination
C) Fugue 1state
Ans: 1A
Feedback: 1An 1illusion 1is 1merely 1a 1misinterpretation 1of 1real 1external 1stimuli. 1In 1this 1case,
1themailman 1is 1looking 1through 1theletters 1before 1he 1puts 1them 1in 1thebox. 1themother 1correctly
1assumes 1he 1is 1sorting 1themail 1but 1her 1schizophrenic 1daughter 1attributes 1his 1actions 1to 1being
1part 1of 1a 1nefarious 1bioterrorism 1plot.
6. A 122-year-old 1man 1is 1brought 1to 1your 1office 1by 1his 1father 1to 1discuss 1his 1son's 1mental
1health 1disorder. 1thepatient 1was 1diagnosed 1with 1schizophrenia 16 1months 1ago 1and 1has 1been
1taking 1medication 1since. 1thefather 1states 1that 1his 1son's 1dose 1isn't 1high 1enough 1and 1you 1need
1to 1raise 1it. 1He 1states 1that 1his 1son 1has 1been 1hearing 1things 1that 1don't 1exist. 1You 1ask 1theyoung
1man 1what 1is 1going 1on 1and 1he 1tells 1you 1that 1his 1father 1is 1just 1jealous 1because 1his 1sister 1talks
1only 1to 1him. 1His 1father 1turns 1to 1him 1and 1says, 1―Son, 1you 1know 1your 1sister 1died 12 1years
1ago!‖ 1His 1son 1replies
―Well, 1she 1still 1talks 1to 1me 1in 1my 1head 1all 1thetime!‖
Which 1best 1describes 1this 1patient's 1abnormality 1of 1perception?
A) Illusion
B) Hallucination
C) Fugue 1state
Ans: 1B
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long does it usually take to develop muscular atrophy with increased prominence of the scapular
spine following a rotator cuff tear?
A) 1 week
B) 2–3 weeks
C) 1 month
7. A 126-year-old 1violinist 1comes 1to 1your 1clinic, 1complaining 1of 1anxiety. 1He 1is 1a 1first 1chair
1violinist 1in 1thelocal 1symphony 1orchestra 1and 1has 1started 1having 1symptoms 1during
1performances, 1such 1as 1sweating, 1shaking, 1and 1hyperventilating. 1It 1has 1gotten 1so 1bad 1that 1he
1has 1thought 1about 1giving 1up 1his 1first 1chair 1status 1so 1he 1does 1not 1have 1to 1play 1thesolo 1during
1one 1of 1themovements. 1He 1says 1that 1he 1never 1has 1these 1symptoms 1during 1rehearsals 1or 1when
1he 1is 1practicing. 1He 1denies 1having 1any 1of 1these 1symptoms 1at 1any 1other 1time. 1His 1past 1medical
1history 1is 1unremarkable. 1He 1denies 1any 1tobacco 1use, 1drug 1use, 1or 1alcohol 1abuse. 1His 1parents
1are 1both 1healthy. 1On 1examination 1you 1see 1a 1young 1man 1who 1appears 1worried. 1His 1vital 1signs
1and 1physical 1examination 1are 1unremarkable.
What 1type 1of 1anxiety 1disorder 1best 1describes 1his 1situation?
A) Panic 1disorder
B) Specific 1phobia
C) Social 1phobia
D) Generalized 1anxiety 1disorder
Ans: 1C
Feedback: 1 Social 1phobia 1is 1a 1marked, 1persistent 1fear 1of 1social 1or 1performance 1situations.
8. A 123-year-old 1ticket 1agent 1is 1brought 1in 1by 1her 1husband 1because 1he 1is 1concerned 1about 1her
1recent 1behavior. 1He 1states 1that 1for 1thelast 12 1weeks 1she 1has 1been 1completely 1out 1of 1control.
1He 1says 1that 1she 1hasn't 1showered 1in 1days, 1stays 1awake 1most 1of 1thenight 1cleaning 1their
1apartment, 1and 1has 1run 1up 1over 1$1,000 1on 1their 1credit 1cards. 1While 1he 1is 1talking, 1thepatient
1interrupts 1him 1frequently 1and 1declares 1this 1is 1all 1untrue 1and 1she 1has 1never 1been 1so 1happy 1and
1fulfilled 1in 1her 1whole 1life. 1She 1speaks 1very 1quickly, 1changing 1thesubject 1often. 1After 1a 1longer
1than 1normal 1interview 1you 1find 1out 1she 1has 1had 1no 1recent 1illnesses 1or 1injuries. 1Her 1past
1medical 1history 1is 1unremarkable. 1Both 1her 1parents 1are 1healthy 1but 1thehusband 1has 1heard
1rumors 1about 1an 1aunt 1with 1similar 1symptoms. 1She 1and 1her 1husband 1have 1no 1children. 1She
1smokes 1one 1pack 1of 1cigarettes 1a 1day 1(although 1she 1has 1been 1chain-smoking 1in 1thelast 12
1weeks), 1drinks 1four 1to 1six 1drinks 1a 1week, 1and 1smokes 1marijuana 1occasionally. 1On
1examination 1she 1is 1very 1loud 1and 1outspoken. 1Her 1physical 1examination 1is 1unremarkable.
Which 1mood 1disorder 1does 1she 1most 1likely 1have?
A) Major 1depressive 1episode
B) Manic 1episode
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C) Dysthymic disorder
Ans: B
Feedback: Mania consists of a persistently elevated mood for at least 1 week with symptoms
such 1as 1inflated 1self-esteem, 1decreased 1need 1for 1sleep, 1pressured 1speech, 1racing 1thoughts, 1and
1involvement 1in 1high-risk 1activities 1(such 1as 1drug 1use, 1spending 1sprees, 1and 1indiscriminate
1sexual 1activity). 1In 1this 1case, 1thepatient 1has 1racing 1thoughts 1and 1pressured 1speech, 1has 1a
1decreased 1need 1for 1sleep, 1and 1is 1engaging 1in 1high-risk 1activities 1(spending 1sprees).
9. A 172-year-old 1African-American 1male 1is 1brought 1to 1your 1clinic 1by 1his 1daughter 1for 1a
1follow- 1up 1visit 1after 1his 1recent 1hospitalization. 1He 1had 1been 1admitted 1to 1thelocal 1hospital 1for
1speech 1problems 1and 1weakness 1in 1his 1right 1arm 1and 1leg. 1On 1admission 1his 1MRI 1showed 1a
1small 1stroke. 1thepatient 1was 1in 1rehab 1for 11 1month 1following 1his 1initial 1presentation. 1He 1is 1now
1walking 1with 1a 1walker 1and 1has 1good 1use 1of 1his 1arm. 1His 1daughter 1complains, 1however, 1that
1everyone 1is 1still 1having 1trouble 1communicating 1with 1thepatient. 1You 1ask 1thepatient 1how 1he
1thinks 1he 1is 1doing. 1Although 1it 1is 1hard 1for 1you 1to 1make 1out 1his 1words 1you 1believe 1his 1answer
1is 1―well 1. 1. 1. 1fine 1. 1. 1. 1doing 1. 1. 1. 1okay.‖ 1His 1prior 1medical 1history 1involved 1high 1blood
1pressure 1and 1coronary 1artery 1disease. 1He 1is 1a 1widower 1and 1retired 1handyman. 1He 1has 1three
1children 1who 1are 1healthy. 1He 1denies 1tobacco, 1alcohol, 1or 1drug 1use. 1He 1has 1no 1other 1current
1symptoms. 1On 1examination 1he 1is 1in 1no 1acute 1distress 1but 1does 1seem 1embarrassed 1when 1it
1takes 1him 1so 1long 1to 1answer. 1His 1blood 1pressure 1is 1150/90 1and 1his 1other 1vital 1signs 1are
1normal. 1Other 1than 1his 1weak 1right 1arm 1and 1leg 1his 1physical 1examination 1is 1unremarkable.
What 1disorder 1of 1speech 1does 1he 1have?
A) Wernicke's 1aphasia
B) Broca's 1aphasia
C) Dysarthria
Ans: 1B
Feedback: 1In 1Broca's 1aphasia 1patients 1articulate 1very 1slowly 1and 1with 1a 1great 1deal 1of 1effort.
1Nouns, 1verbs, 1and 1important 1adjectives 1are 1usually 1present 1and 1only 1small 1grammatical 1words
1are 1dropped 1from 1speech. 1Broca's 1area 1is 1on 1thelateral 1portion 1of 1thefrontal 1lobes.
10. A 135-year-old 1stockbroker 1comes 1to 1your 1office, 1complaining 1of 1feeling 1tired 1and 1irritable.
1She 1also 1says 1she 1feels 1like 1nothing 1ever 1goes 1her 1way 1and 1that 1nothing 1good 1ever 1happens.
1When 1you 1ask 1her 1how 1long 1she 1has 1felt 1this 1way 1she 1laughs 1and 1says, 1―Since 1when 1have 1I
1not?‖ 1She 1relates 1that 1she 1has 1felt 1pessimistic 1about 1life 1in 1general 1since 1she 1was 1in 1high
1school. 1She 1denies 1any 1problems 1with 1sleep, 1appetite, 1or 1concentration, 1and 1states 1she 1hasn't
1thought 1about 1killing 1herself. 1She 1reports 1no 1recent 1illnesses 1or 1injuries. 1She 1is 1single. 1She
1smokes 1one 1pack 1of
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cigarettes a day, drinks occasionally, and hasn't taken any illegal drugs since college. Her mother
suffers from depression and her father has high blood pressure. On examination her vital signs
and physical examination are unremarkable.
What mental health disorder best describes her symptoms?
A) Major depressive episode
B) Dysthymic 1disorder
C) Cyclothymic 1disorder
Ans: 1B
Feedback: 1Someone 1with 1dysthymia 1has 1a 1depressed 1mood 1and 1symptoms 1for 1most 1of 1theday,
1more 1days 1than 1not, 1for 1at 1least 12 1years. 1thedisorder 1generally 1begins 1in 1adolescence 1and 1is
1fairly 1stable 1throughout 1life. 1Although 1thesymptoms 1are 1similar 1to 1those 1of 1major 1depression
1(inthis 1case, 1fatigue 1and 1irritability), 1they 1are 1milder 1and 1fewer.
11. Susanne 1is 1a 127 1year 1old 1who 1has 1had 1headaches, 1muscle 1aches, 1and 1fatigue 1for 1thelast 12
1months. 1You 1have 1completed 1a 1thorough 1history, 1examination, 1and 1laboratory 1workup 1but
1have 1not 1found 1a 1cause. 1 What 1would 1your 1next 1action 1be?
A) A 1referral 1to 1a 1neurologist
B) A 1referral 1to 1a 1rheumatologist
C) To 1tell 1thepatient 1you 1can't 1find 1anything
D) To 1screen 1for 1depression
Ans: 1D
Feedback: 1 Although 1you 1may 1consider 1referrals 1to 1help 1with 1thediagnosis 1and 1treatment 1for
1this 1patient, 1screening 1is 1a 1time-efficient 1way 1to 1recognize 1depression. 1This 1will 1allow 1her 1to
1be 1treated 1more 1expediently. 1You 1may 1tell 1thepatient 1you 1have 1not 1found 1an 1answer 1yet, 1but
1you 1must 1also 1tell 1her 1that 1you 1will 1not 1stop 1looking 1until 1you 1have 1helped 1her.
12. You 1ask 1a 1patient 1to 1draw 1a 1clock. 1He 1fills 1in 1all 1thenumbers 1on 1theright 1half 1of
1thecircle. 1What 1do 1you 1suspect?
A) Hemianopsia
B) Fatigue
C) Oppositional 1defiant 1disorder
D) Depression
Ans: 1A
Feedback: 1 You 1should 1suspect 1a 1visual 1problem 1because 1there 1is 1no 1writing 1on 1one 1half 1of 1the
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circle. This is consistent with a hemianopsia, sometimes seen in stroke. These patients may also
eat food on only one half of their plate. The other conditions would not account for this pattern.
13. A 1young 1woman 1comes 1to 1you 1with 1a 1cut 1on 1her 1finger 1caused 1by 1thelid 1of 1a 1can 1she 1was
1opening. 1She 1is 1pacing 1about 1theroom, 1crying 1loudly, 1and 1through 1her 1sobs 1she 1says, 1―My
1career 1as 1a 1pianist 1is 1finished!‖ 1 Which 1personality 1type 1exhibits 1these 1features?
A) Narcissistic
B) Paranoid
C) Histrionic
D) Avoidant
Ans: 1C
Feedback: 1thetheatrical 1nature 1of 1her 1behavior 1as 1well 1as 1her 1overreaction 1lead 1to 1a 1diagnosis
1of 1histrionic 1character 1disorder.
14. Adam 1is 1a 1very 1successful 115-year-old 1student 1and 1athlete. 1His 1mother 1brings 1him 1in
1today 1because 1he 1no 1longer 1studies, 1works 1out, 1or 1sees 1his 1friends. 1This 1has 1gone 1on 1for 1a
1month 1and 1a 1half. 1When 1you 1speak 1with 1him 1alone 1in 1theroom, 1he 1states 1it 1―would 1be 1better
1if 1he 1were 1not 1here.‖ 1 What 1would 1you 1do 1next?
A) Tell 1him 1that 1he 1has 1a 1very 1promising 1career 1in 1anything 1he 1chooses 1and 1soon 1he 1will
1feel 1better.
B) Tell 1him 1that 1he 1needs 1an 1antidepressant 1and 1it 1will 1take 1about 14 1weeks 1to 1work.
C) Speak 1with 1his 1mother 1about 1getting 1him 1together 1more 1with 1his 1friends.
D) Assess 1his 1suicide 1risk.
Ans: 1D
Feedback: 1His 1lack 1of 1interest 1in 1usual 1activities 1and 1duration 1of 1symptoms 1should 1make 1you
1suspicious 1for 1depression. 1Despite 1his 1very 1successful 1academic 1and 1athletic 1performance, 1you
1should 1recognize 1this 1last 1phrase 1indicating 1suicide 1risk. 1You 1could 1ask 1if 1he 1has 1had
1thoughts 1about 1hurting 1himself 1and, 1if 1so, 1how 1he 1would 1carry 1this 1out. 1Ask 1about 1firearms
1and 1other 1weapons 1at 1home. 1Adam 1needs 1immediate 1psychiatric 1referral 1if 1these 1risks 1are
1found, 1or 1admission 1to 1thehospital 1for 1observation 1if 1referral 1is 1not 1available 1in 1a 1timely
1fashion.
15. A 129-year-old 1woman 1comes 1to 1your 1office. 1 As 1you 1take 1thehistory, 1you 1notice 1that 1she
1is 1speaking 1very 1quickly, 1and 1jumping 1from 1topic 1to 1topic 1so 1rapidly 1that 1you 1have 1trouble
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following her. You are able to find some connections between ideas, but it is difficult. Which
word describes this thought process?
A) Derailment
B) Flight of ideas
C) Circumstantiality
D) Incoherence
Ans: 1B
Feedback: 1This 1represents 1flight 1of 1ideas 1because 1theideas 1are 1connected 1in 1some 1logical 1way.
1Derailment, 1or 1loosening 1of 1associations, 1has 1more 1disconnection 1within 1clauses.
Circumstantiality 1is 1characterized 1by 1thepatient 1speaking 1―around‖ 1thesubject 1and 1using
1excessive 1detail, 1though 1thoughts 1are 1meaningfully 1connected. 1Incoherence 1lacks 1meaningful
1connection 1and 1often 1has 1odd 1grammar 1or 1word 1use. 1Although 1severe 1flight 1of 1ideas 1can
1produce 1this 1condition, 1evidence 1is 1not 1present 1in 1this 1vignette.
16. In 1obtaining 1a 1history, 1you 1note 1that 1a 1patient 1uses 1theword 1―largely‖ 1repeatedly, 1to 1thepoint
1of 1being 1a 1distraction 1to 1your 1task. 1 Which 1word 1best 1describes 1this 1speech 1pattern?
A) Clanging
B) Echolalia
C) Confabulation
D) Perseveration
Ans: 1D
Feedback: 1Perseveration 1is 1therepetition 1of 1words 1or 1ideas. 1Echolalia 1differs 1in 1that 1thepatient
1repeats 1what 1is 1said 1to 1him. 1 Clanging 1is 1therepetition 1of 1thesame 1sounds 1in 1different 1words.
1Confabulation 1is 1making 1up 1a 1story 1in 1response 1to 1a 1question. 1 This 1is 1sometimes 1seen 1in
1chronic 1alcohol 1use 1with 1Korsakoff's 1syndrome.
Chapter 1 20 1 t 1h 1e 1Nervous 1 System
1
Multiple 1Choice
1. A 128-year-old 1book 1editor 1comes 1to 1your 1clinic, 1complaining 1of 1strange 1episodes. 1He
1states 1that 1about 1once 1a 1week 1for 1thelast 13 1months 1his 1left 1hand 1and 1arm 1will 1stiffen 1and 1then
1start 1jerking. 1He 1says 1that 1after 1a 1few 1seconds 1his 1whole 1left 1arm 1and 1then 1his 1left 1leg 1will
1also 1start 1to 1jerk. 1He 1denies 1any 1loss 1of 1consciousness 1or 1loss 1of 1bowel 1or 1bladder 1control.
1When 1thesymptoms 1resolve, 1his 1arm 1and 1leg 1feel 1tired 1but 1otherwise 1he 1feels 1fine. 1His 1past
1medical 1historyis 1significant 1for 1a 1cyst 1in 1his 1brain 1that 1was 1removed 16 1months 1ago. 1He 1is
1married 1and 1has 1two 1children. 1His 1parents 1are 1both 1healthy. 1On 1examination 1you 1see 1a 1scar
1over 1theright 1side 1of 1his 1head 1but 1otherwise 1his 1neurologic 1examination 1is 1unremarkable.
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What type of seizure disorder is he most likely to have?
A) Generalized tonic–clonic seizure
B) Generalized absence seizure
C) Simple partial seizure (Jacksonian)
D) Complex partial seizure
Ans: 1C
Feedback: 1Simple 1partial 1seizures 1start 1with 1a 1unilateral 1symptom, 1involve 1no 1loss 1of
1consciousness, 1and 1have 1a 1normal 1postictal 1state. 1In 1a 1Jacksonian 1seizure 1thesymptoms 1start
1with 1one 1body 1part 1and 1―march‖ 1along 1thesame 1side 1of 1thebody.
2. A 17-year-old 1child 1is 1brought 1to 1your 1clinic 1by 1her 1mother. 1themother 1states 1that 1her
1daughter 1is 1doing 1poorly 1in 1school 1because 1she 1has 1some 1kind 1of 1―ADD‖ 1(attention 1deficit
1disorder). 1You 1ask 1themother 1what 1makes 1her 1think 1thechild 1has 1ADD. 1themother 1tells 1you
1that 1both 1at 1home 1and 1at 1school 1her 1daughter 1will 1just 1zone 1out 1for 1several 1seconds 1and 1lick
1her 1lips. 1She 1states 1it 1happens 1at 1least 1four 1to 1six 1times 1an 1hour. 1She 1says 1this 1has 1been
1happening 1for 1about 1a 1year. 1After 1several 1seconds 1of 1lip-licking 1her 1daughter 1seems 1normal
1again. 1She 1states 1her 1daughter 1has 1been 1generally 1healthy 1with 1just 1normal 1childhood 1colds 1and
1ear 1infections. 1thepatient's 1parents 1are 1both 1healthy 1and 1no 1other 1family 1members 1have 1had
1these 1symptoms.
What 1type 1of 1seizure 1disorder 1is 1she 1most 1likely 1to 1have?
A) Generalized 1tonic–clonic 1seizure
B) Generalized 1absence 1seizure
C) Simple 1partial 1seizure 1(Jacksonian)
D) Complex 1partial 1seizure
Ans: 1B
Feedback: 1 In 1an 1absence 1seizure 1there 1is 1no 1tonic–clonic 1activity. 1There 1is 1a 1sudden, 1brief
1lapse 1of 1consciousness 1with 1blinking, 1staring, 1lip-smacking, 1or 1hand 1movements 1that 1resolve
1quickly 1to 1full 1consciousness. 1It 1is 1easily 1mistaken 1for 1daydreaming 1or 1ADD. 1Some 1will 1try 1to
1induce 1these 1episodes 1with 1hyperventilation.
3. A 137-year-old 1insurance 1agent 1comes 1to 1your 1office, 1complaining 1of 1trembling 1hands. 1She
1says 1that 1for 1thepast 13 1months 1when 1she 1tries 1to 1use 1her 1hands 1to 1fix 1her 1hair 1or 1cook 1they
1shake 1badly. 1She 1says 1she 1doesn't 1feel 1particularly 1nervous 1when 1this 1occurs 1but 1she 1worries
1that 1other 1people 1will 1think 1she 1has 1an 1anxiety 1disorder 1or 1that 1she's 1a 1drinker. 1She 1admits 1to
1having 1some 1recent 1fatigue, 1trouble 1with 1vision, 1and 1difficulty 1maintaining 1bladder 1control.
1Her 1past 1medical 1history 1is 1remarkable 1for 1hypothyroidism. 1Her 1mother 1has 1lupus 1and 1her
1father 1is 1healthy. 1She 1has 1an 1older 1brother 1with 1type 11 1diabetes. 1She 1is 1married 1and 1has 1three
1children. 1She 1denies 1tobacco, 1alcohol, 1or 1drug 1use. 1On 1examination, 1when 1she 1tries 1to 1reach
1for 1a 1pencil 1to 1fill 1out 1thehealth 1form 1she 1has 1obvious 1tremors 1in 1her 1dominant 1hand.
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What type of tremor is she most likely to have?
A) Resting tremor
B) Postural tremor
C) Intention tremor
Ans: 1C
Feedback: 1Intention 1tremors 1are 1absent 1at 1rest 1or 1in 1a 1postural 1position 1and 1occur 1only 1with
1intentional 1movement 1of 1thehands. 1This 1is 1seen 1in 1cerebellar 1disease 1(stroke 1or 1alcohol 1use) 1or
1in 1multiple 1sclerosis. 1This 1patient's 1tremor, 1fatigue, 1bladder 1problems, 1and 1visual 1problems 1are
1suggestive 1of 1multiple 1sclerosis.
4. A 177-year-old 1retired 1school 1superintendent 1comes 1to 1your 1office, 1complaining 1of 1unsteady
1hands. 1He 1says 1that 1for 1thepast 16 1months, 1when 1his 1hands 1are 1resting 1in 1his 1lap 1they 1shake
1uncontrollably. 1He 1says 1when 1he 1holds 1them 1out 1in 1front 1of 1his 1body 1theshaking 1diminishes,
1and 1when 1he 1uses 1his 1hands 1theshaking 1is 1also 1better. 1He 1also 1complains 1of 1some 1difficulty
1getting 1 up 1out 1of 1his 1chair 1and 1walking 1around. 1He 1denies 1any 1recent 1illnesses 1or 1injuries.
1His 1past 1medical 1history 1is 1significant 1for 1high 1blood 1pressure 1and 1coronary 1artery 1disease,
1requiring 1a 1stent 1in 1thepast. 1He 1has 1been 1married 1for 1over 150 1years 1and 1has 1five 1children 1and
112 1grandchildren. 1He 1denies 1any 1tobacco, 1alcohol, 1or 1drug 1use. 1His 1mother 1died 1of 1a 1stroke 1in
1her 170s 1and 1his 1father 1died 1of 1a 1heart 1attack 1in 1his 160s. 1He 1has 1a 1younger 1sister 1who 1has
1arthritis 1problems. 1His 1children 1are 1all 1essentially 1healthy. 1On 1examination 1you 1see 1a 1fine,
1pill-rolling 1tremor 1of 1his 1left 1hand. 1His 1right 1shows 1less 1movement. 1His 1cranial 1nerve
1examination 1is 1normal. 1He 1has 1some 1difficulty 1rising 1from 1his 1chair, 1his 1gait 1is 1slow, 1and 1it
1takes 1him 1time 1to 1turn 1around 1to 1walk 1back 1toward 1you. 1He 1has 1almost 1no 1―arm 1swing‖ 1with
1his 1gait.
What 1type 1of 1tremor 1is 1he 1most 1likely 1to 1have?
A) Resting 1tremor
B) Postural 1tremor
C) Intention 1tremor
Ans: 1A
Feedback: 1Resting 1tremors 1occur 1when 1thehands 1are 1literally 1at 1rest, 1such 1as 1sitting 1in 1thelap.
1These 1are 1slow, 1fine 1tremors, 1such 1as 1thepill-rolling 1seen 1in 1Parkinson's 1disease, 1which 1this
1patient 1most 1likely 1has. 1Decreased 1arm 1swing 1with 1ambulation 1is 1one 1of 1theearliest 1objective
1findings 1of 1Parkinson's 1disease.
5. A 148-year-old 1grocery 1store 1manager 1comes 1to 1your 1clinic, 1complaining 1of 1her 1head 1being
―stuck‖ 1to 1one 1side. 1She 1says 1that 1today 1she 1was 1doing 1her 1normal 1routine 1when 1it 1suddenly
1felt 1like 1her 1head 1was 1being 1moved 1to 1her 1left 1and 1then 1it 1just 1stuck 1that 1way. 1She 1says 1it 1is
1somewhat 1painful 1because 1she 1cannot 1get 1it 1moved 1back 1to 1normal. 1She 1denies 1any 1recent
1neck 1trauma. 1Her 1past 1medical 1history 1consists 1of 1type 12 1diabetes 1and 1gastroparesis 1(slowmoving 1peristalsis 1in 1the
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digestive tract, seen in diabetes). She is on oral medication for each. She is married and has three
children. She denies tobacco, alcohol, or drug use. Her father has diabetes and her mother passed
away from breast cancer. Her children are healthy. On examination you see a slightly overweight
Hispanic woman appearing her stated age. Her head is twisted grotesquely to her left but
otherwise her examination is normal.
What 1form 1of 1involuntary 1movement 1does 1she 1have?
A) Chorea
B) Asbestosis
C) Tic
D) Dystonia
Ans: 1D
Feedback: 1Dystonia 1involves 1large 1movements 1of 1thebody, 1such 1as 1with 1thehead 1or
1trunk, 1leading 1to 1grotesque 1twisted 1postures. 1Some 1medications 1(such 1as 1one 1commonly
1used 1for 1gastroparesis) 1often 1cause 1dystonia.
6. A 141-year-old 1real 1estate 1agent 1comes 1to 1your 1office, 1complaining 1that 1he 1feels 1like 1his 1face
1is 1paralyzed 1on 1theleft. 1He 1states 1that 1last 1week 1he 1felt 1his 1left 1eyelid 1was 1drowsy 1and 1as
1theday 1progressed 1he 1was 1unable 1to 1close 1his 1eyelid 1all 1theway. 1Later 1he 1felt 1like 1his 1smile
1became 1affected 1also. 1He 1denies 1any 1recent 1injuries 1but 1had 1an 1upper 1respiratory 1viral
1infection 1last 1month. 1His 1past 1medical 1history 1is 1unremarkable. 1He 1is 1divorced 1and 1has 1one
1child. 1He 1smokes 1one 1pack 1of 1cigarettes 1a 1day, 1occasionally 1drinks 1alcohol, 1and 1denies 1any
1illegal 1drug 1use. 1His 1mother 1has 1high 1blood 1pressure 1and 1his 1father 1has 1sarcoidosis. 1On
1examination 1you 1ask 1him 1to 1close 1his 1eyes. 1He 1is 1unable 1to 1close 1his 1left 1eye. 1You 1ask 1him 1to
1open 1his 1eyes 1and 1raise 1his 1eyebrows. 1His 1right 1forehead 1furrows 1but 1his 1left 1remains 1flat.
1You 1then 1ask 1him 1to 1give 1you 1a 1big 1smile. 1theright 1corner 1of 1his 1mouth 1raises 1but 1theleft 1side
1of 1his 1mouth 1remains 1thesame. 1What 1type 1of 1facial 1paralysis 1does 1he 1have?
A) Peripheral 1CN 1VII 1paralysis
B) Central 1CN 1VII 1paralysis
Ans: 1A
=
Feedback: 1In 1a 1peripheral 1lesion 1theentire 1side 1of 1theface 1will 1be 1involved. 1This 1causes
1theinability 1to 1close 1theeye, 1raise 1theeyebrow, 1wrinkle 1theforehead, 1and 1smile 1on 1theaffected
1side.Bell's 1palsy 1is 1an 1example 1of 1this 1type 1of 1paralysis 1and 1is 1probably 1what 1is 1affecting 1this
1patient.
7. A 160-year-old 1retired 1seamstress 1comes 1to 1your 1office, 1complaining 1of 1decreased 1sensation
1in 1her 1hands 1and 1feet. 1She 1states 1that 1she 1began 1to 1have 1theproblems 1in 1her 1feet 1a 1year 1ago 1but
1now 1it 1has 1started 1in 1her 1hands 1also. 1She 1also 1complains 1of 1some 1weakness 1in 1her 1grip. 1She
1has 1had 1no
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recent illnesses or injuries. Her past medical history consists of having type 2 diabetes for 20
years. She now takes insulin and oral medications for her diabetes. She has been married for 40
years. She has two healthy children. Her mother has Alzheimer's disease and coronary artery
disease. Her father died of a stroke and also had diabetes. She denies any tobacco, alcohol, or
drug use. On examination she has decreased deep tendon reflexes in the patellar and Achilles
tendons. 1She 1has 1decreased 1sensation 1of 1fine 1touch, 1pressure, 1and 1vibration 1on 1both 1feet. 1She
1has 1decreased 1two-point 1discrimination 1on 1her 1hands. 1Her 1grip 1strength 1is 1decreased 1and 1her
1plantar 1and 1dorsiflexion 1strength 1is 1decreased.
Where 1is 1thedisorder 1of 1theperipheral 1nervous 1system 1in 1this 1patient?
A) Anterior 1horn 1cell
B) Spinal 1root 1and 1nerve
C) Peripheral 1polyneuropathy
D) Neuromuscular 1junction
Ans: 1C
Feedback: 1With 1peripheral 1polyneuropathy 1there 1will 1be 1distal 1extremity 1symptoms 1before
1proximal 1symptoms. 1There 1will 1be 1weakness 1and 1atrophy 1and 1decreased 1sensory 1sensations.
1There 1is 1often 1theclassic 1glove-stocking 1distribution 1pattern 1of 1thelower 1legs 1and 1hands.
1Causes 1include 1diabetic 1neuropathy, 1as 1in 1this 1case, 1alcoholism, 1and 1vitamin 1deficiencies.
8. A 121-year-old 1engineering 1student 1comes 1to 1your 1office, 1complaining 1of 1leg 1and 1back 1pain
1and 1of 1tripping 1when 1he 1walks. 1He 1states 1this 1started 13 1months 1ago 1with 1back 1and 1buttock
1pain 1but 1has 1since 1progressed 1to 1feeling 1weak 1in 1his 1left 1leg. 1He 1denies 1any 1bowel 1or 1bladder
1symptoms. 1He 1can 1think 1of 1no 1specific 1traumatic 1incidences 1but 1he 1was 1a 1defensive 1lineman
1in 1high 1school 1and 1junior 1college. 1His 1past 1medical 1history 1is 1unremarkable. 1He 1denies
1tobacco 1use 1or 1alcohol 1or 1drug 1abuse. 1His 1parents 1are 1both 1healthy. 1On 1examination 1he 1is
1tender 1over 1thelumbar 1spine 1and 1he 1has 1a 1positive 1straight-leg 1raise 1on 1theleft. 1His 1Achilles
1tendon 1deep 1reflex 1is 1decreased 1on 1theleft. 1While 1watching 1his 1gait 1you 1notice 1he 1has 1to 1pick
1his 1left 1foot 1up 1high 1inorder 1not 1to 1trip.
What 1abnormality 1of 1gait 1does 1he 1most 1likely 1have?
A) Sensory 1ataxia
B) Parkinsonian 1gait
C) Steppage 1gait
D) Spastic 1hemiparesis
Ans: 1C
Feedback: 1This 1gait 1is 1associated 1with 1foot 1drop, 1usually 1secondary 1to 1a 1lower 1motor 1neuron
1disease. 1This 1is 1often 1seen 1with 1a 1herniated 1disc, 1such 1as 1in 1this 1patient.
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recent illnesses or injuries. Her past medical history consists of having type 2 diabetes for 20
years. She now takes insulin and oral medications for her diabetes. She has been married for 40
years. She has two healthy children. Her mother has Alzheimer's disease and coronary artery
disease. Her father died of a stroke and also had diabetes. She denies any tobacco, alcohol, or
drug use. On examination she has decreased deep tendon reflexes in the patellar and Achilles
neurologic 1examination, 1you 1get 1a 1penlight.
What 1size 1pupils 1do 1you 1expect 1to 1see 1in 1this 1comatose 1patient?
A) Pinpoint 1pupils
B) Large 1pupils
C) Asymmetric 1pupils
D) Irregularly 1shaped 1pupils
Ans: 1A
Feedback: 1Narcotics 1and 1cholinergics 1cause 1very 1small 1(1 1mm) 1pupils. 1Reactions 1to 1light 1can
1be 1appreciated 1with 1a 1magnifying 1glass.
10. A 137-year-old 1woman 1is 1brought 1into 1your 1emergency 1room 1comatose. 1theparamedics 1say
1her 1husband 1found 1her 1unconscious 1in 1her 1home. 1Her 1past 1medical 1history 1consists 1of 1type 11
1diabetes 1and 1she 1is 1on 1insulin. 1In 1theambulance 1theparamedics 1obtained 1a 1glucose 1check 1and
1her 1sugar 1was 115 1(normal 1is 170 1to 1105). 1They 1began 1a 1dextrose 1saline 1infusion 1and 1intubated
1her 1to 1protect 1her 1airway. 1Despite 1their 1efforts, 1she 1is 1posturing 1in 1theemergency 1room 1with
1her 1arms 1straight 1at 1her 1side 1and 1her 1jaw 1clenched. 1Her 1legs 1are 1also 1straight 1and 1her 1feet 1are
1plantar 1flexed. 1What 1type 1of 1posturing 1is 1she 1showing?
A) Decorticate 1rigidity
B) Decerebrate 1rigidity
C) Hemiplegia
D) Chorea
Ans: 1B
Feedback: 1In 1this 1type 1of 1rigidity 1thejaws 1are 1clenched 1and 1theneck 1is 1extended. 1thearms 1are
1adducted 1and 1stiffly 1extended 1at 1theelbows 1with 1forearms 1pronated 1and 1wrists 1and 1fingers
1flexed. 1thelegs 1are 1stiffly 1extended 1at 1theknees 1with 1thefeet 1plantar 1flexed. 1This 1posture 1occurs 1with
1lesions 1in 1thediencephalon, 1midbrain, 1or 1pons. 1It 1can 1also 1be 1seen 1with 1severe 1metabolic
1disordersuch 1as 1hypoxia 1or 1hypoglycemia, 1as 1in 1this 1case.
11. A 1patient 1presents 1with 1a 1left-sided 1facial 1droop. 1On 1further 1testing, 1you 1note 1that 1he
1is 1unable 1to 1wrinkle 1his 1forehead 1on 1theleft 1and 1has 1decreased 1taste. 1Which 1of
1thefollowing 1is 1true?
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
A) This represents a central lesion.
B) This represents a CN IV lesion.
C) This may be related to travel.
D) This most likely represents a stroke.
Ans: 1C
Feedback: 1Because 1theforehead 1is 1also 1involved, 1this 1represents 1a 1peripheral 1nerve 1lesion 1of
1CN 1VII 1and 1does 1not 1represent 1a 1classic 1middle 1cerebral 1artery 1stroke. 1thelatter 1would 1spare
1theupper 1face 1but 1include 1speech 1difficulties 1as 1well 1as 1upper 1extremity 1weakness 1on
1theipsilateral 1side.
One 1cause 1of 1this 1type 1of 1lesion 1is 1Lyme 1disease 1and 1relates 1to 1travel 1to 1endemic 1areas, 1so 1a
1careful 1travel 1history 1should 1be 1sought.
12. Which 1is 1true 1of 1examination 1of 1theolfactory 1nerve?
A) It 1is 1not 1tested 1for 1laterality.
B) The 1smell 1must 1be 1identified 1to 1declare 1a 1normal 1response.
C) Abnormal 1responses 1may 1be 1seen 1in 1otherwise 1normal 1elderly.
D) Allergies 1are 1unrelated 1to 1testing 1of 1this 1nerve.
Ans: 1C
Feedback: 1Abnormal 1olfactory 1nerve 1examination 1findings 1may 1be 1seen 1in 1otherwise 1normal
1elderly 1but 1may 1also 1be 1associated 1with 1other 1conditions 1such 1as 1Parkinson's 1disease. 1You
1should 1try 1to 1determine 1if 1only 1one 1side 1is 1abnormal 1by 1occluding 1thecontralateral 1nostril.
1thesmell 1must 1only 1be 1detected, 1not 1identified 1by 1name, 1to 1indicate 1a 1normal 1examination. 1If
1nasal 1occlusion 1occurs 1for 1other 1reasons, 1such 1a 1allergic 1rhinitis 1or 1anatomic 1abnormalities,
1thenerve 1cannot 1be 1tested 1and 1may 1seem 1to 1be 1abnormal 1for 1unrelated 1reasons.
13. Steve 1has 1had 1a 1stroke 1and 1comes 1to 1you 1for 1follow-up 1today. 1On 1examination 1you 1find
1that 1he 1has 1increased 1muscle 1tone, 1some 1involuntary 1movements, 1an 1abnormal 1gait, 1and 1a
1slowness 1of 1response 1in 1movements.
1 He 1most 1likely 1has 1involvement 1of 1which 1of
1thefollowing?
A) The 1corticospinal 1tract
B) The 1cerebellum
C) The 1cerebrum
D) The 1basal 1ganglia
Ans: 1D
Feedback: 1 These 1findings 1are 1typical 1of 1disease 1in 1the 1basal 1ganglia.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
14. You are conducting a mental status examination and note impairment of speech and
judgement, but the rest of your examination is intact. Where is the most likely location of the
problem?
A) Cerebrum
B) Cerebellum
C) Brainstem
D) Basal 1ganglia
Ans: 1A
Feedback: 1The 1cerebrum 1is 1responsible 1for 1higher 1cognitive 1functions 1such 1as 1speech 1and
1judgement.
15. A 1patient 1presents 1with 1a 1daily 1headache 1which 1has 1worsened 1over 1the 1past 1several
1months. 1On 1funduscopic 1examination, 1you 1notice 1that 1the 1disk 1edge 1is 1indistinct 1and 1the
1veins 1do 1not 1pulsate. 1 Which 1is 1most 1likely?
A) Migraine
B) Glaucoma
C) Visual 1acuity 1problem
D) Increased 1intracranial 1pressure
Ans: 1D
Feedback: 1This 1is 1a 1description 1of 1papilledema, 1which 1should 1make 1you 1think 1of 1increased
1intracranial 1pressure. 1This 1can 1be 1a 1critical 1finding. 1This 1patient 1may 1have 1a 1brain 1tumor 1or
1benign 1intracranial 1hypertension. 1 These 1findings 1cannot 1be 1ignored 1and 1should 1be 1acted 1upon
1quickly.
16. A 1young 1woman 1comes 1in 1today, 1complaining 1of 1fatigue, 1irregular 1menses, 1and
1polyuria 1which 1have 1gradually 1increased 1over 1the 1past 1few 1months. 1Which 1eye 1findings
1would 1be 1consistent 1with 1her 1condition?
A) An 1upper 1quadrantanopsia
B) A 1lower 1quadrantanopsia
C) A 1bitemporal 1hemianopsia
D) An 1increased 1cup-to-disc 1ratio
Ans: 1C
Feedback: 1These 1symptoms 1are 1consistent 1with 1a 1pituitary 1lesion. 1Enlargement 1of 1a 1tumor 1in
1this 1area 1would 1compress 1the 1fibers 1responsible 1for 1the 1lateral 1visual 1fields. 1 A
1quadrantanopsia
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
would usually be caused by a lesion in the optic radiations in the parietal lobe of the cerebrum.
Glaucoma would cause a narrowing of the entire visual field, not just the lateral aspects.
17. A 1patient 1with 1a 1history 1of 1seizure 1disorder 1and 1on 1several 1seizure 1medications 1says 1a
1friend 1noted 1―jumping 1eye 1movements.‖ 1The 1patient 1describes 1a 1sensation 1of 1movement 1at
1rest 1since 1his 1medications 1were 1adjusted 1upward 1following 1a 1breakthrough 1seizure 1several
1weeks 1ago. 1On 1examination 1you 1note 1that 1the 1eyes 1both 1slowly 1move 1to 1the 1right 1and 1then
1quickly 1jump 1to 1the 1left. 1 Which 1of 1the 1following 1is 1true?
A) This 1is 1called 1nystagmus 1to 1the 1left
B) This 1is 1called 1saccadic 1eye 1movement
C) This 1represents 1a 1subclinical 1seizure
D) This 1most 1likely 1has 1an 1ominous 1cause
Ans: 1A
Feedback: 1Nystagmus 1is 1named 1for 1the 1fast 1component, 1in 1this 1case, 1toward 1the 1left.
1 Nystagmus 1is 1common 1with 1several 1seizure 1medications 1and 1in 1this 1case 1is 1likely 1due 1to 1the
1recent 1increase 1in 1medications 1rather 1than 1a 1more 1ominous 1cause. 1 Saccadic 1eye 1movements
1are 1similar 1to 1nystagmus 1but 1represent 1fixations 1on 1apparently 1moving 1objects, 1like 1watching
1roadside 1trees 1from 1a 1moving 1vehicle. 1A 1subclinical 1seizure 1with 1bilateral 1findings 1and 1no
1effect 1on 1consciousness 1would 1be 1unusual.
18. You 1are 1testing 1the 1biceps 1strength 1in 1a 1young 1man 1following 1a 1spinal 1trauma 1from 1a
1motor 1vehicle 1accident. 1He 1cannot 1lift 1his 1hand 1upward, 1but 1if 1the 1arm 1is 1abducted 1to 190
1degrees, 1he 1can 1then 1move 1his 1forearm 1side 1to 1side. 1 This 1would 1represent 1which 1muscle
1strength 1grading?
A) I
B) II
C) III
D) IV
Ans: 1B
Feedback: 1 The 1ability 1to 1move 1an 1extremity, 1but 1not 1against 1gravity, 1represents 1a 1strength 1of
12 1out 1of 15. 1 Zero 1represents 1no 1muscular 1contraction 1detected 1(not 1even 1a 1―flicker‖); 1one
1represents 1a 1contraction 1but 1no 1movement 1of 1the 1extremity; 1three 1means 1that 1the 1extremity 1can
1move 1against 1gravity 1but 1not 1against 1resistance; 1four 1means 1perceived 1weakness 1but 1the 1patient
1can 1oppose 1some 1resistance; 1and 1five 1is 1normal.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
19. You ask a patient to hold her arms up, with her palms up, and then to close her eyes. The
right arm begins to move downward after a few seconds and her thumb rotates upward. This is
most likely a problem with which part of the nervous system?
A) Corticospinal tract
B) Spinothalamic 1tract
C) Thalamus
D) Dorsal 1root 1ganglion
Ans: 1A
Feedback: 1 This 1describes 1a 1pronator 1drift, 1which 1signifies 1decreased 1position 1sense
1involvement 1of 1the 1corticospinal 1tract. 1This 1tract 1does 1not 1travel 1through 1the 1thalamus. 1This 1is
1commonly 1tested 1as 1an 1early 1sign 1of 1stroke. 1 This 1would 1not 1occur 1with 1a 1dorsal 1root 1ganglion
1problem.
20. You 1are 1examining 1a 1child 1with 1severe 1cerebral 1palsy. 1When 1you 1suddenly 1move 1his
1foot 1dorsally, 1a 1sustained 1―beating‖ 1of 1the 1foot 1against 1your 1hand 1ensues. 1 What 1does 1this
1represent?
A) A 1focal 1seizure
B) Clonus
C) Extinction
D) Reinforcement
Ans: 1B
Feedback: 1Clonus 1is 1a 1sustained 1rhythmic 1―beating‖ 1which 1correlates 1with 1CNS 1disease 1and
1hyperreflexia. 1A 1focal 1seizure 1could 1be 1virtually 1ruled 1out 1by 1stopping 1the 1stimulus 1and
1watching 1the 1phenomenon 1stop. 1Extinction 1is 1a 1term 1applied 1to 1sensory 1testing 1where 1one 1side
1of 1a 1simultaneous, 1bilateral 1stimulus 1is 1not 1felt 1because 1of 1damage 1to 1the 1cortex.
1Reinforcement 1applies 1to 1enhancing 1reflex 1examination 1by 1distracting 1the 1patient, 1for 1example,
1by 1pulling 1his 1hands 1against 1each 1other.
21. Jim 1is 1an 1HIV-positive 1patient 1who 1complains 1about 1back 1pain 1in 1addition 1to 1several
1other 1problems. 1On 1percussion, 1there 1is 1slight 1tenderness 1over 1the 1T7 1vertebrae, 1and 1when 1you
1flex 1his 1thigh 1to 190 1degrees 1and 1extend 1his 1lower 1legs, 1you 1meet 1strong 1resistance 1at 1about 145
1degrees 1of 1extension. 1 What 1are 1likely 1causes 1of 1this 1constellation 1of 1symptoms?
A) Fractured 1vertebrae
B) Malingering
C) Infection
D) Medication 1side 1effect
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Ans: C
Feedback: This represents Kernig's sign. When present bilaterally it often indicates meningeal
irritation. (Kernig was a physician in eastern Europe and treated many children with tuberculous
meningitis.) It is useful in cases when there has been chronic inflammation of the meninges, as
seen 1in 1TB 1and 1cryptococcal 1disease. 1There 1was 1no 1trauma 1reported, 1and 1these 1signs 1are 1too
1important 1to 1ascribe 1them 1to 1malingering. 1Such 1localized 1physical 1findings 1are 1unlikely 1to 1be
1caused 1by 1medication 1side 1effects.
22. A 1patient 1with 1alcoholism 1is 1brought 1in 1with 1confusion. 1You 1ask 1him 1to 1―stop 1traffic‖
1with 1his 1palms 1and 1notice 1that 1every 1few 1seconds 1his 1palms 1suddenly 1move 1toward 1the
1floor. 1What 1does 1this 1indicate?
A) Stroke
B) Metabolic 1problems
C) Carpal 1tunnel 1syndrome
D) Severe 1fatigue 1and 1weakness
Ans: 1B
Feedback: 1This 1is 1asterixis 1and 1represents 1the 1inability 1to 1maintain 1a 1sustained 1contraction 1of
1the 1muscles. 1It 1is 1usually 1due 1to 1various 1metabolic 1diseases. 1A 1variant 1of 1this 1is 1called
1―milkmaid's 1grip‖ 1in 1which 1the 1patient 1is 1asked 1to 1grasp 1two 1fingers. 1A 1positive 1occurs 1if 1the
1patient 1is 1unable 1to 1sustain 1the 1grip 1and 1it 1feels 1as 1if 1the 1patient 1is 1trying 1to 1milk 1a 1cow. 1Most
1would 1consider 1checking 1an 1ammonia 1level 1in 1this 1patient. 1A 1stroke 1is 1less 1likely 1to 1produce
1bilateral 1symptoms. 1Carpal 1tunnel 1represents 1a 1sensory 1loss 1in 1the 1median 1nerve 1distribution.
23. You 1examine 1a 1―sleepy‖ 1patient. 1 You 1note 1that 1she 1will 1open 1her 1eyes 1and 1look 1at 1you
1but 1responds 1slowly 1and 1is 1confused. 1She 1does 1not 1appear 1interested 1in 1her 1surroundings.
1How 1would 1you 1describe 1her 1level 1of 1consciousness?
A) Lethargic
B) Obtunded
C) Stuporous
D) Comatose
Ans: 1B
Chapter 121 1Reproductive 1Systems
1
MULTIPLE 1CHOICE
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
1. The external male genital structures include the:
a. Testis.
b. Scrotum.
c. Epididymis.
d. Vas 1deferens.
ANS: 1B
The 1external 1male 1genital 1structures 1include 1the 1penis 1and 1scrotum. 1The 1testis, 1epididymis, 1and
1
vas 1deferens 1are 1internal 1structures.
2. An 1accessory 1glandular 1structure 1for 1the 1male 1genital 1organs 1is 1the:
a. Testis.
b. Scrotum.
c. Prostate.
d. Vas 1deferens.
ANS: 1C
Glandular 1structures 1accessory 1to 1the 1male 1genital 1organs 1are 1the 1prostate, 1seminal 1vesicles, 1and
1
bulbourethral 1glands.
3. Which 1of 1these 1statements 1is 1true 1regarding 1the 1penis?
a. The 1urethral 1meatus 1is 1located 1on 1the 1ventral 1side 1of 1the 1penis.
b. The 1prepuce 1is 1the 1fold 1of 1foreskin 1covering 1the 1shaft 1of 1the 1penis.
c. The 1penis 1is 1made 1up 1of 1two 1cylindrical 1columns 1of 1erectile 1tissue.
d. The 1corpus 1spongiosum 1expands 1into 1a 1cone 1of 1erectile 1tissue 1called 1the 1glans.
ANS: 1D
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
At the distal end of the shaft, the corpus spongiosum expands into a cone of erectile tissue, the
glans. The penis is made up of three cylindrical columns of erectile tissue. The skin that covers
the glans of the penis is the prepuce. The urethral meatus forms at the tip of the glans.
4. When 1performing 1a 1genital 1examination 1on 1a 125-year-old 1man, 1the 1nurse 1notices 1deeply
1
pigmented, 1wrinkled 1scrotal 1skin 1with 1large 1sebaceous 1follicles. 1On 1the 1basis 1of 1this
information, 1the 1nurse 1would:
1
a. Squeeze 1the 1glans 1to 1check 1for 1the 1presence 1of 1discharge.
b. Consider 1this 1finding 1as 1normal, 1and 1proceed 1with 1the 1examination.
c. Assess 1the 1testicles 1for 1the 1presence 1of 1masses 1or 1painless 1lumps.
d. Obtain 1a 1more 1detailed 1history, 1focusing 1on 1any 1scrotal 1abnormalities 1the
1patient 1has 1noticed.
ANS: 1B
After 1adolescence, 1the 1scrotal 1skin 1is 1deeply 1pigmented 1and 1has 1large 1sebaceous 1follicles 1and
1
appears 1corrugated.
5. Which 1statement 1concerning 1the 1testes 1is 1true?
a. The 1lymphatic 1vessels 1of 1the 1testes 1drain 1into 1the 1abdominal 1lymph 1nodes.
b. The 1vas 1deferens 1is 1located 1along 1the 1inferior 1portion 1of 1each 1testis.
c. The 1right 1testis 1is 1lower 1than 1the 1left 1because 1the 1right 1spermatic 1cord 1is 1longer.
d. The 1cremaster 1muscle 1contracts 1in 1response 1to 1cold 1and 1draws 1the 1testicles
1closer 1to 1the 1body.
ANS: 1D
When 1it 1is 1cold, 1the 1cremaster 1muscle 1contracts, 1which 1raises 1the 1scrotal 1sac 1and 1brings 1the
testes 1closer 1to 1the 1body 1to 1absorb 1heat 1necessary 1for 1sperm 1viability. 1The 1lymphatic 1vessels
1
1
of 1the 1testes 1drain 1into 1the 1inguinal 1lymph 1nodes. 1The 1vas 1deferens 1is 1located 1along 1the 1upper
portion 1of 1each 1testis. 1The 1left 1testis 1is 1lower 1than 1the 1right 1because 1the 1left 1spermatic 1cord 1is
1
1
longer.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
6. A male patient with possible fertility problems asks the nurse where sperm is produced. The
nurse knows that sperm production occurs in the:
a. Testes.
b. Prostate.
c. Epididymis.
d. Vas 1deferens.
ANS: 1A
Sperm 1production 1occurs 1in 1the 1testes, 1not 1in 1the 1other 1structures 1listed.
7. A 162-year-old 1man 1states 1that 1his 1physician 1told 1him 1that 1he 1has 1an 1inguinal 1hernia. 1He
asks 1the 1nurse 1to 1explain 1what 1a 1hernia 1is. 1The 1nurse 1should:
1
a. Tell 1him 1not 1to 1worry 1and 1that 1most 1men 1his 1age 1develop 1hernias.
b. Explain 1that 1a 1hernia 1is 1often 1the 1result 1of 1prenatal 1growth 1abnormalities.
c. Refer 1him 1to 1his 1physician 1for 1additional 1consultation 1because 1the 1physician
1made 1the 1initial 1diagnosis.
d. Explain 1that 1a 1hernia 1is 1a 1loop 1of 1bowel 1protruding 1through 1a 1weak 1spot 1in
1the 1abdominal 1muscles.
ANS: 1D
A 1hernia 1is 1a 1loop 1of 1bowel 1protruding 1through 1a 1weak 1spot 1in 1the 1musculature. 1The 1other 1options
1
are 1not 1correct 1responses 1to 1the 1patients 1question.
8. The 1mother 1of 1a 110-year-old 1boy 1asks 1the 1nurse 1to 1discuss 1the 1recognition 1of 1puberty.
The 1nurse 1should 1reply 1by 1saying:
1
a. Puberty 1usually 1begins 1around 115 1years 1of 1age.
b. The 1first 1sign 1of 1puberty 1is 1an 1enlargement 1of 1the 1testes.
c. The 1penis 1size 1does 1not 1increase 1until 1about 116 1years 1of 1age.
d. The 1development 1of 1pubic 1hair 1precedes 1testicular 1or 1penis 1enlargement.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
6. A male patient with possible fertility problems asks the nurse where sperm is produced. The
nurse knows that sperm production occurs in the:
a. Testes.
size 1increases.
9. During 1an 1examination 1of 1an 1aging 1man, 1the 1nurse 1recognizes 1that 1normal 1changes 1to
expect 1would 1be:
1
a. Enlarged 1scrotal 1sac.
b. Increased 1pubic 1hair.
c. Decreased 1penis 1size.
d. Increased 1rugae 1over 1the 1scrotum.
ANS: 1C
In 1the 1aging 1man, 1the 1amount 1of 1pubic 1hair 1decreases, 1the 1penis 1size 1decreases, 1and 1the 1rugae
1
over 1the 1scrotal 1sac 1decreases. 1The 1scrotal 1sac 1does 1not 1enlarge.
10. An 1older 1man 1is 1concerned 1about 1his 1sexual 1performance. 1The 1nurse 1knows 1that 1in
the 1absence 1of 1disease, 1a 1withdrawal 1from 1sexual 1activity 1later 1in 1life 1may 1be
1
1
attributable 1to:
a. Side 1effects 1of 1medications.
b. Decreased 1libido 1with 1aging.
c. Decreased 1sperm 1production.
d. Decreased 1pleasure 1from 1sexual 1intercourse.
ANS: 1A
In 1the 1absence 1of 1disease, 1a 1withdrawal 1from 1sexual 1activity 1may 1be 1attributable 1to 1side 1effects
of
1
1
medications 1such 1as 1antihypertensives, 1antidepressants, 1sedatives, 1psychotropics,
antispasmotics, 1tranquilizers 1or 1narcotics, 1and 1estrogens. 1The 1other 1options 1are 1not 1correct.
1
11. A 159-year-old 1patient 1has 1been 1diagnosed 1with 1prostatitis 1and 1is 1being 1seen 1at 1the 1clinic
for 1complaints 1of 1burning 1and 1pain 1during 1urination. 1He 1is 1experiencing:
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
a. Dysuria.
b. Nocturia.
c. Polyuria.
d. 1 Hematuria.
ANS: 1A
Dysuria 1(burning 1with 1urination) 1is 1common 1with 1acute 1cystitis, 1prostatitis, 1and 1urethritis.
1
Nocturia 1is 1voiding 1during 1the 1night. 1Polyuria 1is 1voiding 1in 1excessive 1quantities. 1Hematuria 1is
1
voiding 1with 1blood 1in 1the 1urine.
12. A 145-year-old 1mother 1of 1two 1children 1is 1seen 1at 1the 1clinic 1for 1complaints 1of 1losing 1my
urine 1when 1I 1sneeze. 1The 1nurse 1documents 1that 1she 1is 1experiencing:
1
a. Urinary 1frequency.
b. Enuresis.
c. Stress 1incontinence.
d. Urge 1incontinence.
ANS: 1C
Stress 1incontinence 1is 1involuntary 1urine 1loss 1with 1physical 1strain, 1sneezing, 1or 1coughing 1that
1
occurs 1as 1a 1result 1to 1weakness 1of 1the 1pelvic 1floor. 1Urinary 1frequency 1is 1urinating 1more 1times
than 1usual 1(more 1than 1five 1to 1six 1times 1per 1day). 1Enuresis 1is 1involuntary 1passage 1of 1urine 1at
1
night 1after 1age 15 1to 16 1years 1(bed 1wetting). 1Urge 1incontinence 1is 1involuntary 1urine 1loss 1from
1
1
overactive 1detrusor 1muscle 1in 1the 1bladder. 1It 1contracts, 1causing 1an 1urgent 1need 1to 1void.
13. When 1the 1nurse 1is 1conducting 1sexual 1history 1from 1a 1male 1adolescent, 1which 1statement
would 1be 1most 1appropriate 1to 1use 1at 1the 1beginning 1of 1the 1interview?
1
a. Do 1you 1use 1condoms?
b. You 1dont 1masturbate, 1do 1you?
c. Have 1you 1had 1sex 1in 1the 1last 16 1months?
d. Often 1adolescents 1your 1age 1have 1questions 1about 1sexual 1activity.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
ANS: D
The interview should begin with a permission statement, which conveys that it is normal and
acceptable to think or feel a certain way. Sounding judgmental should be avoided.
14. Which 1of 1these 1statements 1is 1most 1appropriate 1when 1the 1nurse 1is 1obtaining 1a
genitourinary 1history 1from 1an 1older 1man?
1
a. Do 1you 1need 1to 1get 1up 1at 1night 1to 1urinate?
b. Do 1you 1experience 1nocturnal 1emissions, 1or 1wet 1dreams?
c. Do 1you 1know 1how 1to 1perform 1a 1testicular 1self-examination?
d. Has 1anyone 1ever 1touched 1your 1genitals 1when 1you 1did 1not 1want 1them 1to?
ANS: 1A
The 1older 1male 1patient 1should 1be 1asked 1about 1the 1presence 1of 1nocturia. 1Awaking 1at 1night 1to
1
urinate 1may 1be 1attributable 1to 1a 1diuretic 1medication, 1fluid 1retention 1from 1mild 1heart 1failure 1or
1
varicose 1veins, 1or 1fluid 1ingestion 13 1hours 1before 1bedtime, 1especially 1coffee 1and 1alcohol. 1The
1
other 1questions 1are 1more 1appropriate 1for 1younger 1men.
15. When 1the 1nurse 1is 1performing 1a 1genital 1examination 1on 1a 1male 1patient, 1the 1patient 1has
an 1erection. 1The 1nurses 1most 1appropriate 1action 1or 1response 1is 1to:
1
a. Ask 1the 1patient 1if 1he 1would 1like 1someone 1else 1to 1examine 1him.
b. Continue 1with 1the 1examination 1as 1though 1nothing 1has 1happened.
c. Stop 1the 1examination, 1leave 1the 1room 1while 1stating 1that 1the 1examination
1will 1resume 1at 1a 1later 1time.
d. Reassure 1the 1patient 1that 1this 1is 1a 1normal 1response 1and 1continue 1with
1the 1examination.
ANS: 1D
When 1the 1male 1patient 1has 1an 1erection, 1the 1nurse 1should 1reassure 1the 1patient 1that 1this 1is 1a
normal 1physiologic 1response 1to 1touch 1and 1proceed 1with 1the 1rest 1of 1the 1examination. 1The 1other
1
responses 1are 1not 1correct 1and 1may 1be 1perceived 1as 1judgmental.
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
16. The nurse is examining the glans and knows which finding is normal for this area?
a. The meatus may have a slight discharge when the glans is compressed.
b. Hair is without pest inhabitants.
c. The 1skin 1is 1wrinkled 1and 1without 1lesions.
d. Smegma 1may 1be 1present 1under 1the 1foreskin 1of 1an 1uncircumcised 1male.
ANS: 1D
The 1glans 1looks 1smooth 1and 1without 1lesions 1and 1does 1not 1have 1hair. 1The 1meatus 1should 1not
1
have 1any 1discharge 1when 1the 1glans 1is 1compressed. 1Some 1cheesy 1smegma 1may 1have 1collected
under 1the 1foreskin 1of 1an 1uncircumcised 1male.
1
17. When 1performing 1a 1genitourinary 1assessment, 1the 1nurse 1notices 1that 1the 1urethral 1meatus
is 1ventrally 1positioned. 1This 1finding 1is:
1
a. Called 1hypospadias.
b. A 1result 1of 1phimosis.
c. Probably 1due 1to 1a 1stricture.
d. Often 1associated 1with 1aging.
ANS: 1A
Normally, 1the 1urethral 1meatus 1is 1positioned 1just 1about 1centrally. 1Hypospadias 1is 1the 1ventral
1
location 1of 1the 1urethral 1meatus. 1The 1position 1of 1the 1meatus 1does 1not 1change 1with 1aging.
Phimosis 1is 1the 1inability 1to 1retract 1the 1foreskin. 1A 1stricture 1is 1a 1narrow 1opening 1of 1the 1meatus.
1
18. The 1nurse 1is 1performing 1a 1genital 1examination 1on 1a 1male 1patient 1and 1notices 1urethral
1
drainage. 1When 1collecting 1urethral 1discharge 1for 1microscopic 1examination 1and 1culture, 1the
nurse 1should:
1
a. Ask 1the 1patient 1to 1urinate 1into 1a 1sterile 1cup.
b. Ask 1the 1patient 1to 1obtain 1a 1specimen 1of 1semen.
c. Insert 1a 1cotton-tipped 1applicator 1into 1the 1urethra.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
16. The nurse is examining the glans and knows which finding is normal for this area?
a. The meatus may have a slight discharge when the glans is compressed.
b. Hair is without pest inhabitants.
If 1urethral 1discharge 1is 1noticed, 1then 1the 1examiner 1should 1collect 1a 1smear 1for 1microscopic
1
examination 1and 1culture 1by 1compressing 1the 1glans 1anteroposteriorly 1between 1the 1thumb 1and
1
forefinger. 1The 1other 1options 1are 1not 1correct 1actions.
19. When 1assessing 1the 1scrotum 1of 1a 1male 1patient, 1the 1nurse 1notices 1the 1presence 1of
multiple 1firm, 1nontender, 1yellow 11-cm 1nodules. 1The 1nurse 1knows 1that 1these 1nodules 1are
1
1
most 1likely:
a. From 1urethritis.
b. Sebaceous 1cysts.
c. Subcutaneous 1plaques.
d. From 1an 1inflammation 1of 1the 1epididymis.
ANS: 1B
Sebaceous 1cysts 1are 1commonly 1found 1on 1the 1scrotum. 1These 1yellowish 11-cm 1nodules 1are 1firm,
1
nontender, 1and 1often 1multiple. 1The 1other 1options 1are 1not 1correct.
20. When 1performing 1a 1scrotal 1assessment, 1the 1nurse 1notices 1that 1the 1scrotal 1contents 1show 1a
red 1glow 1with 1transillumination. 1On 1the 1basis 1of 1this 1finding 1the 1nurse 1would:
1
a. Assess 1the 1patient 1for 1the 1presence 1of 1a 1hernia.
b. Suspect 1the 1presence 1of 1serous 1fluid 1in 1the 1scrotum.
c. Consider 1this 1finding 1normal, 1and 1proceed 1with 1the 1examination.
d. Refer 1the 1patient 1for 1evaluation 1of 1a 1mass 1in 1the 1scrotum.
ANS: 1B
Normal 1scrotal 1contents 1do 1not 1allow 1light 1to 1pass 1through 1the 1scrotum. 1However, 1serous 1fluid
1
does 1transilluminate 1and 1shows 1as 1a 1red 1glow. 1Neither 1a 1mass 1nor 1a 1hernia 1would
transilluminate.
1
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
21. During a health history, a 22-year old woman asks, Can I get that vaccine for human
papilloma virus (HPV)? I have genital warts and Id like them to go away! What is the nurses best
response?
a. The 1HPV 1vaccine 1is 1for 1girls 1and 1women 1ages 19 1to 126 1years, 1so 1we 1can 1start
1that 1today.
b. This 1vaccine 1is 1only 1for 1girls 1who 1have 1not 1yet 1started 1to 1become 1sexually 1active.
c. Lets 1check 1with 1the 1physician 1to 1see 1if 1you 1are 1a 1candidate 1for 1this 1vaccine.
d. The 1vaccine 1cannot 1protect 1you 1if 1you 1already 1have 1an 1HPV 1infection.
ANS: 1D
The 1HPV 1vaccine 1is 1appropriate 1for 1girls 1and 1women 1age 19 1to 126 1years 1and 1is 1administered 1to
1
prevent 1cervical 1cancer 1by 1preventing 1HPV 1infections 1before 1girls 1become 1sexually 1active.
However, 1it 1cannot 1protect 1the 1woman 1if 1an 1HPV 1infection 1is 1already 1present.
22. During 1an 1examination, 1the 1nurse 1observes 1a 1female 1patients 1vestibule 1and 1expects 1to 1see 1the:
a. Urethral 1meatus 1and 1vaginal 1orifice.
b. Vaginal 1orifice 1and 1vestibular 1(Bartholin) 1glands.
c. Urethral 1meatus 1and 1paraurethral 1(Skene) 1glands.
d. Paraurethral 1(Skene) 1and 1vestibular 1(Bartholin) 1glands.
ANS: 1A
The 1labial 1structures 1encircle 1a 1boat-shaped 1space, 1or 1cleft, 1termed 1the 1vestibule. 1Within 1the
1
vestibule 1are 1numerous 1openings. 1The 1urethral 1meatus 1and 1vaginal 1orifice 1are 1visible. 1The
ducts 1of 1the 1paraurethral 1(Skene) 1glands 1and 1the 1vestibular 1(Bartholin) 1glands 1are 1present 1but
1
1
not 1visible.
23. During 1a 1speculum 1inspection 1of 1the 1vagina, 1the 1nurse 1would 1expect 1to 1see 1what 1at 1the 1end
of 1the 1vaginal 1canal?
1
a. Cervix
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
b. Uterus
c. Ovaries
d. Fallopian tubes
ANS: 1A
At 1the 1end 1of 1the 1canal, 1the 1uterine 1cervix 1projects 1into 1the 1vagina.
24. The 1uterus 1is 1usually 1positioned 1tilting 1forward 1and 1superior 1to 1the 1bladder. 1This 1position
is 1known 1as:
1
a. Anteverted 1and 1anteflexed.
b. Retroverted 1and 1anteflexed.
c. Retroverted 1and 1retroflexed.
d. Superiorverted 1and 1anteflexed.
ANS: 1A
The 1uterus 1is 1freely 1movable, 1not 1fixed, 1and 1usually 1tilts 1forward 1and 1superior 1to 1the 1bladder 1(a
1
position 1labeled 1as 1anteverted 1and 1anteflexed).
25. An 111-year-old 1girl 1is 1in 1the 1clinic 1for 1a 1sports 1physical 1examination. 1The 1nurse 1notices
1
that 1she 1has 1begun 1to 1develop 1breasts, 1and 1during 1the 1conversation 1the 1girl 1reveals 1that 1she 1is
worried 1about 1her 1development. 1The 1nurse 1should 1use 1which 1of 1these 1techniques 1to 1best 1assist
1
1
the 1young 1girl 1in 1understanding 1the 1expected 1sequence 1for 1development? 1The 1nurse 1should:
a. Use 1the 1Tanner 1scale 1on 1the 1five 1stages 1of 1sexual 1development.
b. Describe 1her 1development 1and 1compare 1it 1with 1that 1of 1other 1girls 1her 1age.
c. Use 1the 1Jacobsen 1table 1on 1expected 1development 1on 1the 1basis 1of 1height
1and 1weight 1data.
d. Reassure 1her 1that 1her 1development 1is 1within 1normal 1limits 1and 1tell 1her 1not
1to 1worry 1about 1the 1next 1step.
ANS: 1A
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
The Tanner scale on the five stages of pubic hair development is helpful in teaching girls the
expected sequence of sexual development (see Table 26-1). The other responses are not
appropriate.
26. A 1woman 1who 1is 18 1weeks 1pregnant 1is 1in 1the 1clinic 1for 1a 1checkup. 1The 1nurse 1reads 1on 1her
chart 1that 1her 1cervix 1is 1softened 1and 1looks 1cyanotic. 1The 1nurse 1knows 1that 1the 1woman 1is
1
1
exhibiting
sign 1and
sign.
a. Tanner; 1Hegar
b. Hegar; 1Goodell
c. Chadwick; 1Hegar
d. Goodell; 1Chadwick
ANS: 1D
Shortly 1after 1the 1first 1missed 1menstrual 1period, 1the 1female 1genitalia 1show 1signs 1of 1the 1growing
1
fetus. 1The 1cervix 1softens 1(Goodell 1sign) 1at 14 1to 16 1weeks, 1and 1the 1vaginal 1mucosa 1and 1cervix
look 1cyanotic 1(Chadwick 1sign) 1at 18 1to 112 1weeks. 1These 1changes 1occur 1because 1of 1increased
1
1
vascularity 1and 1edema 1of 1the 1cervix 1and 1hypertrophy 1and 1hyperplasia 1of 1the 1cervical 1glands.
Hegar 1sign 1occurs 1when 1the 1isthmus 1of 1the 1uterus 1softens 1at 16 1to 18 1weeks. 1Tanner 1sign 1is 1not 1a
1
correct 1response.
27. Generally, 1the 1changes 1normally 1associated 1with 1menopause 1occur 1because 1the 1cells 1in
the 1reproductive 1tract 1are:
1
a. Aging.
b. Becoming 1fibrous.
c. Estrogen 1dependent.
d. Able 1to 1respond 1to 1estrogen.
ANS: 1C
Because 1cells 1in 1the 1reproductive 1tract 1are 1estrogen 1dependent, 1decreased 1estrogen 1levels 1during
1
menopause 1bring 1dramatic 1physical 1changes. 1The 1other 1options 1are 1not 1correct.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
28. The nurse is reviewing the changes that occur with menopause. Which changes are
associated with menopause?
a. Uterine and ovarian atrophy, along with a thinning of the vaginal epithelium
b. Ovarian 1atrophy, 1increased 1vaginal 1secretions, 1and 1increasing 1clitoral 1size
c. Cervical 1hypertrophy, 1ovarian 1atrophy, 1and 1increased 1acidity 1of 1vaginal 1secretions
d. Vaginal 1mucosa 1fragility, 1increased 1acidity 1of 1vaginal 1secretions, 1and
1uterine 1hypertrophy
ANS: 1A
The 1uterus 1shrinks 1because 1of 1its 1decreased 1myometrium. 1The 1ovaries 1atrophy 1to 11 1to 12 1cm
1
and 1are 1not 1palpable 1after 1menopause. 1The 1sacral 1ligaments 1relax, 1and 1the 1pelvic 1musculature
1
weakens; 1consequently, 1the 1uterus 1droops. 1The 1cervix 1shrinks 1and 1looks 1paler 1with 1a 1thick
1
glistening 1epithelium. 1The 1vaginal 1epithelium 1atrophies, 1becoming 1thinner, 1drier, 1and 1itchy.
The 1vaginal 1pH 1becomes 1more 1alkaline, 1and 1secretions 1are 1decreased, 1which 1results 1in 1a
1
1
fragile 1mucosal 1surface 1that 1is 1at 1risk 1for 1vaginitis.
29. 1A 154-year-old 1woman 1who 1has 1just 1completed 1menopause 1is 1in 1the 1clinic 1today 1for 1a
1
yearly 1physical 1examination. 1Which 1of 1these 1statements 1should 1the 1nurse 1include 1in 1patient
education? 1A 1postmenopausal 1woman:
1
a. Is 1not 1at 1any 1greater 1risk 1for 1heart 1disease 1than 1a 1younger 1woman.
b. Should 1be 1aware 1that 1she 1is 1at 1increased 1risk 1for 1dyspareunia 1because 1of
1decreased 1vaginal 1secretions.
c. Has 1only 1stopped 1menstruating; 1there 1really 1are 1no 1other 1significant 1changes
1with 1which 1she 1should 1be 1concerned.
d. Is 1likely 1to 1have 1difficulty 1with 1sexual 1pleasure 1as 1a 1result 1of 1drastic 1changes
1in 1the 1female 1sexual 1response 1cycle.
ANS: 1B
Decreased 1vaginal 1secretions 1leave 1the 1vagina 1dry 1and 1at 1risk 1for 1irritation 1and 1pain 1with
1
intercourse 1(dyspareunia). 1The 1other 1statements 1are 1incorrect.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
30. A woman is in the clinic for an annual gynecologic examination. The nurse should plan to
begin the interview with the:
a. Menstrual history, because it is generally nonthreatening.
b. Obstetric 1history, 1because 1it 1includes 1the 1most 1important 1information.
c. Urinary 1system 1history, 1because 1problems 1may 1develop 1in 1this 1area 1as 1well.
d. Sexual 1history, 1because 1discussing 1it 1first 1will 1build 1rapport.
ANS: 1A
Menstrual 1history 1is 1usually 1nonthreatening 1and 1therefore 1a 1good 1topic 1with 1which 1to 1begin 1the
1
interview. 1Obstetric, 1urinary, 1and 1sexual 1histories 1are 1also 1part 1of 1the 1interview 1but 1not
1
necessarily 1the 1best 1topics 1with 1which 1to 1start.
31. A 1patient 1has 1had 1three 1pregnancies 1and 1two 1live 1births. 1The 1nurse 1would 1record
this 1information 1as 1grav , 1para
1
, 1AB
.
a. 2; 12; 11
b. 3; 12; 10
c. 3; 12; 11
d. 3; 13; 11
ANS: 1C
Gravida 1(grav) 1is 1the 1number 1of 1pregnancies. 1Para 1is 1the 1number 1of 1births. 1Abortions 1are
1
interrupted 1pregnancies, 1including 1elective 1abortions 1and 1spontaneous 1miscarriages.
32. During 1the 1interview 1with 1a 1female 1patient, 1the 1nurse 1gathers 1data 1that 1indicate 1the 1patient
is 1perimenopausal. 1Which 1of 1these 1statements 1made 1by 1this 1patient 1leads 1to 1this 1conclusion?
1
a. I 1have 1noticed 1that 1my 1muscles 1ache 1at 1night 1when 1I 1go 1to 1bed.
b. I 1will 1be 1very 1happy 1when 1I 1can 1stop 1worrying 1about 1having 1a 1period.
c. I 1have 1been 1noticing 1that 1I 1sweat 1a 1lot 1more 1than 1I 1used 1to, 1especially 1at 1night.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
d. I have only been pregnant twice, but both times I had breast tenderness as my first
symptom.
ANS: C
Hormone 1shifts 1occur 1during 1the 1perimenopausal 1period, 1and 1associated 1symptoms 1of
menopause 1may 1occur, 1such 1as 1hot 1flashes, 1night 1sweats, 1numbness 1and 1tingling, 1headache,
1
1
palpitations, 1drenching 1sweats, 1mood 1swings, 1vaginal 1dryness, 1and 1itching. 1The 1other
1
responses 1are 1not 1correct.
33. A 150-year-old 1woman 1calls 1the 1clinic 1because 1she 1has 1noticed 1some 1changes 1in 1her 1body
and 1breasts 1and 1wonders 1if 1these 1changes 1could 1be 1attributable 1to 1the 1hormone 1replacement
1
1
therapy 1(HRT) 1she 1started 13 1months 1earlier. 1The 1nurse 1should 1tell 1her:
a. HRT 1is 1at 1such 1a 1low 1dose 1that 1side 1effects 1are 1very 1unusual.
b. HRT 1has 1several 1side 1effects, 1including 1fluid 1retention, 1breast 1tenderness,
1and 1vaginal 1bleeding.
c. Vaginal 1bleeding 1with 1HRT 1is 1very 1unusual; 1I 1suggest 1you 1come 1into 1the
1clinic 1immediately 1to 1have 1this 1evaluated.
d. It 1sounds 1as 1if 1your 1dose 1of 1estrogen 1is 1too 1high; 1I 1think 1you 1may 1need 1to
1decrease 1the 1amount 1you 1are 1taking 1and 1then 1call 1back 1in 1a 1week.
ANS: 1B
Side 1effects 1of 1HRT 1include 1fluid 1retention, 1breast 1pain, 1and 1vaginal 1bleeding. 1The 1other
1
responses 1are 1not 1correct.
34. A 152-year-old 1patient 1states 1that 1when 1she 1sneezes 1or 1coughs 1she 1wets 1herself 1a 1little. 1She
is 1very 1concerned 1that 1something 1may 1be 1wrong 1with 1her. 1The 1nurse 1suspects 1that 1the
1
1
problem 1is:
a. Dysuria.
b. Stress 1incontinence.
c. Hematuria.
d. Urge 1incontinence.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
ANS: B
Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing. Dysuria
is pain or burning with urination. Hematuria is bleeding with urination. Urge incontinence is
involuntary 1urine 1loss 1that 1occurs 1as 1a 1result 1of 1an 1overactive 1detrusor 1muscle 1in 1the 1bladder
that 1contracts 1and 1causes 1an 1urgent 1need 1to 1void.
1
35. During 1the 1interview, 1a 1patient 1reveals 1that 1she 1has 1some 1vaginal 1discharge. 1She 1is
worried 1that 1it 1may 1be 1a 1sexually 1transmitted 1infection. 1The 1nurses 1most 1appropriate
1
1
response 1to 1this 1would 1be:
a. Oh, 1dont 1worry. 1Some 1cyclic 1vaginal 1discharge 1is 1normal.
b. Have 1you 1been 1engaging 1in 1unprotected 1sexual 1intercourse?
c. Id 1like 1some 1information 1about 1the 1discharge. 1What 1color 1is 1it?
d. Have 1you 1had 1any 1urinary 1incontinence 1associated 1with 1the 1discharge?
ANS: 1C
Questions 1that 1help 1the 1patient 1reveal 1more 1information 1about 1her 1symptoms 1should 1be 1asked 1in
a 1nonthreatening 1manner. 1Asking 1about 1the 1amount, 1color, 1and 1odor 1of 1the 1vaginal 1discharge
1
1
provides 1the 1opportunity 1for 1further 1assessment. 1Normal 1vaginal 1discharge 1is 1small, 1clear 1or
1
cloudy, 1and 1always 1nonirritating.
36. A 1woman 1states 1that 12 1weeks 1ago 1she 1had 1a 1urinary 1tract 1infection 1that 1was 1treated 1with
an 1antibiotic. 1As 1a 1part 1of 1the 1interview, 1the 1nurse 1should 1ask, 1Have 1you 1noticed 1any:
1
a. Changes 1in 1your 1urination 1patterns?
b. Excessive 1vaginal 1bleeding?
c. Unusual 1vaginal 1discharge 1or 1itching?
d. Changes 1in 1your 1desire 1for 1intercourse?
ANS: 1C
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Several medications may increase the risk of vaginitis. Broad-spectrum antibiotics alter the
balance of normal flora, which may lead to the development of vaginitis. The other questions are
not appropriate.
37. Which 1statement 1would 1be 1most 1appropriate 1when 1the 1nurse 1is 1introducing 1the 1topic 1of
sexual 1relationships 1during 1an 1interview?
1
a. Now, 1it 1is 1time 1to 1talk 1about 1your 1sexual 1history. 1When 1did 1you 1first
1have 1intercourse?
b. Women 1often 1feel 1dissatisfied 1with 1their 1sexual 1relationships. 1Would 1it 1be 1okay
1to 1discuss 1this 1now?
c. Women 1often 1have 1questions 1about 1their 1sexual 1relationship 1and 1how 1it
1affects 1their 1health. 1Do 1you 1have 1any 1questions?
d. Most 1women 1your 1age 1have 1had 1more 1than 1one 1sexual 1partner. 1How 1many
1would 1you 1say 1you 1have 1had?
ANS: 1C
The 1nurse 1should 1begin 1with 1an 1open-ended 1question 1to 1assess 1individual 1needs. 1The 1nurse
1
should 1include 1appropriate 1questions 1as 1a 1routine 1part 1of 1the 1health 1history, 1because 1doing 1so
1
communicates 1that 1the 1nurse 1accepts 1the 1individuals 1sexual 1activity 1and 1believes 1it 1is
1
important. 1The 1nurses 1comfort 1with 1the 1discussion 1prompts 1the 1patients 1interest 1and, 1possibly,
relief 1that 1the 1topic 1has 1been 1introduced. 1The 1initial 1discussion 1establishes 1a 1database 1for
1
1
comparison 1with 1any 1future 1sexual 1activities 1and 1provides 1an 1opportunity 1to 1screen 1sexual
1
problems.
Chapter 1 22 1 Putting 1 it 1 All 1 Together
MULTIPLE 1CHOICE
1. An 185-year-old 1man 1has 1come 1in 1for 1a 1physical 1examination, 1and 1the 1nurse 1notices 1that 1he
uses 1a 1cane. 1When 1documenting 1general 1appearance, 1the 1nurse 1should 1document 1this
1
1
information 1under 1the 1section 1that 1covers:
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
a. Posture.
b. Mobility.
c. Mood and affect.
d. 1 Physical 1deformity.
ANS: 1B
Use 1of 1assistive 1devices 1would 1be 1documented 1under 1the 1mobility 1section. 1The 1other 1responses
1
are 1all 1other 1categories 1of 1the 1general 1appearance 1section 1of 1the 1health 1history.
2. The 1nurse 1is 1performing 1a 1vision 1examination. 1Which 1of 1these 1charts 1is 1most 1widely 1used
for 1vision 1examinations?
1
a. Snellen
b. Shetllen
c. Smoollen
d. Schwellon
ANS: 1A
The 1Snellen 1eye 1chart 1is 1most 1widely 1used 1for 1vision 1examinations. 1The 1other 1options 1are 1not
1
tests 1for 1vision 1examinations.
3. After 1the 1health 1history 1has 1been 1obtained 1and 1before 1beginning 1the 1physical 1examination,
the 1nurse 1should 1first 1ask 1the 1patient 1to:
1
a. Empty 1the 1bladder.
b. Completely 1disrobe.
c. Lie 1on 1the 1examination 1table.
d. Walk 1around 1the 1room.
ANS: 1A
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Before beginning the examination, the nurse should ask the person to empty the bladder (save the
specimen if needed), disrobe except for underpants, put on a gown, and sit with the legs dangling
off side of the bed or table.
4. During 1a 1complete 1health 1assessment, 1how 1would 1the 1nurse 1test 1the 1patients 1hearing?
a. Observing 1how 1the 1patient 1participates 1in 1normal 1conversation
b. Using 1the 1whispered 1voice 1test
c. Using 1the 1Weber 1and 1Rinne 1tests
d. Testing 1with 1an 1audiometer
ANS: 1B
During 1the 1complete 1health 1assessment, 1the 1nurse 1should 1test 1hearing 1with 1the 1whispered 1voice
1
test. 1The 1other 1options 1are 1not 1correct.
5. A 1patient 1states, 1Whenever 1I 1open 1my 1mouth 1real 1wide, 1I 1feel 1this 1popping 1sensation 1in 1front
of 1my 1ears. 1To 1further 1examine 1this, 1the 1nurse 1would:
1
a. Place 1the 1stethoscope 1over 1the 1temporomandibular 1joint, 1and 1listen 1for 1bruits.
b. Place 1the 1hands 1over 1his 1ears, 1and 1ask 1him 1to 1open 1his 1mouth 1really 1wide.
c. Place 1one 1hand 1on 1his 1forehead 1and 1the 1other 1on 1his 1jaw, 1and 1ask 1him 1to 1try
1to 1open 1his 1mouth.
d. Place 1a 1finger 1on 1his 1temporomandibular 1joint, 1and 1ask 1him 1to 1open 1and 1close
1his 1mouth.
ANS: 1D
The 1nurse 1should 1palpate 1the 1temporomandibular 1joint 1by 1placing 1his 1or 1her 1fingers 1over 1the
joint 1as 1the 1person 1opens 1and 1closes 1the 1mouth.
1
6. The 1nurse 1has 1just 1completed 1an 1examination 1of 1a 1patients 1extraocular 1muscles. 1When
1
documenting 1the 1findings, 1the 1nurse 1should 1document 1the 1assessment 1of 1which 1cranial
nerves?
1
a. II, 1III, 1and 1VI
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b. II, IV, and V
c. III, IV, and V
d. III, IV, and VI
ANS: 1D
Extraocular 1muscles 1are 1innervated 1by 1cranial 1nerves 1III, 1IV, 1and 1VI.
7. A 1patients 1uvula 1raises 1midline 1when 1she 1says 1ahh, 1and 1she 1has 1a 1positive 1gag 1reflex.
The 1nurse 1has 1just 1tested 1which 1cranial 1nerves?
1
a. IX 1and 1X
b. IX 1and 1XII
c. X 1and 1XII
d. XI 1and 1XII
ANS: 1A
Cranial 1nerves 1IX 1and 1X 1are 1being 1tested 1by 1having 1the 1patient 1say 1ahh, 1noting 1the 1mobility 1of 1the
1
uvula, 1and 1when 1assessing 1the 1patients 1gag 1reflex.
8. During 1an 1examination, 1the 1nurse 1notices 1that 1a 1patient 1is 1unable 1to 1stick 1out 1his 1tongue.
Which 1cranial 1nerve 1is 1involved 1with 1the 1successful 1performance 1of 1this 1action?
1
a. I
b. V
c. XI
d. XII
ANS: 1D
Cranial 1nerve 1XII 1enables 1the 1person 1to 1stick 1out 1his 1or 1her 1tongue.
9. A 1patient 1is 1unable 1to 1shrug 1her 1shoulders 1against 1the 1nurses 1resistant 1hands. 1What
cranial 1nerve 1is 1involved 1with 1successful 1shoulder 1shrugging?
1
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a. VII
b. IX
c. XI
d. 1 1 XII
ANS: 1C
Cranial 1nerve 1XI 1enables 1the 1patient 1to 1shrug 1her 1shoulders 1against 1resistance.
10. During 1an 1examination, 1a 1patient 1has 1just 1successfully 1completed 1the 1finger-to-nose 1and
1
the 1rapid-alternating-movements 1tests 1and 1is 1able 1to 1run 1each 1heel 1down 1the 1opposite 1shin. 1The
nurse 1will 1conclude 1that 1the 1patients
1
function 1is 1intact.
a. Occipital
b. Cerebral
c. Temporal
d. Cerebellar
ANS: 1D
The 1nurse 1should 1test 1cerebellar 1function 1of 1the 1upper 1extremities 1by 1using 1the 1finger-to-nose
test 1or 1rapid-alternating-movements 1test. 1The 1nurse 1should 1test 1cerebellar 1function 1of 1the 1lower
1
1
extremities 1by 1asking 1the 1person 1to 1run 1each 1heel 1down 1the 1opposite 1shin.
11. When 1the 1nurse 1performs 1the 1confrontation 1test, 1the 1nurse 1has 1assessed:
a. Extraocular 1eye 1muscles 1(EOMs).
b. Pupils 1(pupils 1equal, 1round, 1reactive 1to 1light, 1and 1accommodation 1[PERRLA]).
c. Near 1vision.
d. Visual 1fields.
ANS: 1D
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The confrontation test assesses visual fields. The other options are not tested with the
confrontation test.
12. Which statement is true regarding the complete physical assessment?
a. The 1male 1genitalia 1should 1be 1examined 1in 1the 1supine 1position.
b. The 1patient 1should 1be 1in 1the 1sitting 1position 1for 1examination 1of 1the 1head 1and 1neck.
c. The 1vital 1signs, 1height, 1and 1weight 1should 1be 1obtained 1at 1the 1end 1of
1the 1examination.
d. To 1promote 1consistency 1between 1patients, 1the 1examiner 1should 1not 1vary 1the
1order 1of 1the 1assessment.
ANS: 1B
The 1head 1and 1neck 1should 1be 1examined 1in 1the 1sitting 1position 1to 1best 1palpate 1the 1thyroid 1and
1
lymph 1nodes. 1The 1male 1patient 1should 1stand 1during 1an 1examination 1of 1the 1genitalia. 1Vital
signs 1are 1measured 1early 1in 1the 1assessment. 1The 1sequence 1of 1the 1assessment 1may 1need 1to
1
1
vary 1according 1to 1different 1patient 1situations.
13. Which 1of 1these 1is 1included 1in 1an 1assessment 1of 1general 1appearance?
a. Height
b. Weight
c. Skin 1color
d. Vital 1signs
ANS: 1C
General 1appearance 1includes 1items 1such 1as 1level 1of 1consciousness, 1skin 1color, 1nutritional
status, 1posture, 1mobility, 1facial 1expression, 1mood 1and 1affect, 1speech, 1hearing, 1and 1personal
1
1
hygiene.
Height, 1weight, 1and 1vital 1signs 1are 1considered 1measurements.
14. The 1nurse 1should 1wear 1gloves 1for 1which 1of 1these 1examinations?
a. Measuring 1vital 1signs
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b. Palpation of the sinuses
c. Palpation of the mouth and tongue
d. Inspection of the eye with an ophthalmoscope
ANS: 1C
Gloves 1should 1be 1worn 1when 1the 1examiner 1is 1exposed 1to 1the 1patients 1body 1fluids.
15. The 1nurse 1should 1use 1which 1location 1for 1eliciting 1deep 1tendon 1reflexes?
a. Achilles
b. Femoral
c. Scapular
d. Abdominal
ANS: 1A
Deep 1tendon 1reflexes 1are 1elicited 1in 1the 1biceps, 1triceps, 1brachioradialis, 1patella, 1and 1Achilles 1heel.
16. During 1an 1inspection 1of 1a 1patients 1face, 1the 1nurse 1notices 1that 1the 1facial 1features
are 1symmetric. 1This 1finding 1indicates 1which 1cranial 1nerve 1is 1intact?
1
a. VII
b. IX
c. XI
d. XII
ANS: 1A
Cranial 1nerve 1VII 1is 1responsible 1for 1facial 1symmetry.
17. During 1inspection 1of 1the 1posterior 1chest, 1the 1nurse 1should 1assess 1for:
a. Symmetric 1expansion.
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b. Symmetry of shoulders and muscles.
c. Tactile fremitus.
d. Diaphragmatic excursion.
ANS: 1B
During 1an 1inspection 1of 1the 1posterior 1chest, 1the 1nurse 1should 1inspect 1for 1symmetry 1of
shoulders 1and 1muscles, 1configuration 1of 1the 1thoracic 1cage, 1and 1skin 1characteristics.
1
Symmetric 1expansion 1and 1tactile 1fremitus 1are 1assessed 1with 1palpation; 1diaphragmatic
1
1
excursion 1is 1assessed 1with 1percussion.
18. During 1an 1examination, 1the 1patient 1tells 1the 1nurse 1that 1she 1sometimes 1feels 1as 1if 1objects
are 1spinning 1around 1her. 1The 1nurse 1would 1document 1that 1she 1occasionally 1experiences:
1
a. Vertigo.
b. Tinnitus.
c. Syncope.
d. Dizziness.
ANS: 1A
Vertigo 1is 1the 1sensation 1of 1a 1person 1moving 1around 1in 1space 1(subjective) 1or 1of 1the 1person 1sensing
1
objects 1moving 1around 1him 1or 1her 1(objective) 1and 1is 1a 1result 1of 1a 1disturbance 1of 1equilibratory
1
apparatus
19. A 1patient 1tells 1the 1nurse, 1Sometimes 1I 1wake 1up 1at 1night 1and 1I 1have 1real 1trouble 1breathing.
1
I 1have 1to 1sit 1up 1in 1bed 1to 1get 1a 1good 1breath. 1When 1documenting 1this 1information, 1the 1nurse
would 1note:
1
a. Orthopnea.
b. Acute 1emphysema.
c. Paroxysmal 1nocturnal 1dyspnea.
d. Acute 1shortness 1of 1breath 1episode.
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ANS: C
Paroxysmal nocturnal dyspnea occurs when the patient awakens from sleep with shortness of
breath and needs to be upright to achieve comfort
20. During 1the 1examination 1of 1a 1patient, 1the 1nurse 1notices 1that 1the 1patient 1has 1several 1small,
1
flat 1macules 1on 1the 1posterior 1portion 1of 1her 1thorax. 1These 1macules 1are 1less 1than 11 1cm 1wide.
Another 1name 1for 1these 1macules 1is:
1
a. Warts.
b. Bullae.
c. Freckles.
d. Papules.
ANS: 1C
A 1macule 1is 1solely 1a 1lesion 1with 1color 1change, 1flat 1and 1circumscribed, 1less 1than 11 1cm. 1Macules
1
are 1also 1known 1as 1freckles
21. During 1an 1examination, 1the 1nurse 1notices 1that 1a 1patients 1legs 1turn 1white 1when 1they 1are
raised 1above 1the 1patients 1head. 1The 1nurse 1should 1suspect:
1
a. Lymphedema.
b. Raynaud 1disease.
c. Chronic 1arterial 1insufficiency.
d. Chronic 1venous 1insufficiency.
ANS: 1C
Elevational 1pallor 1(striking) 1indicates 1arterial 1insufficiency
22. The 1nurse 1documents 1that 1a 1patient 1has 1coarse, 1thickened 1skin 1and 1brown 1discoloration
over 1the 1lower 1legs. 1Pulses 1are 1present. 1This 1finding 1is 1probably 1the 1result 1of:
1
a. Lymphedema.
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b. Raynaud disease.
c. Chronic arterial insufficiency.
d. Chronic venous insufficiency.
ANS: 1D
Chronic 1venous 1insufficiency 1would 1exhibit 1firm 1brawny 1edema, 1coarse 1thickened 1skin, 1normal
1
pulses, 1and 1brown 1discoloration
23. The 1nurse 1notices 1that 1a 1patient 1has 1ulcerations 1on 1the 1tips 1of 1the 1toes 1and 1on 1the 1lateral
aspect 1of 1the 1ankles. 1This 1finding 1indicates:
1
a. Lymphedema.
b. Raynaud 1disease.
c. Arterial 1insufficiency.
d. Venous 1insufficiency.
ANS: 1C
Ulcerations 1on 1the 1tips 1of 1the 1toes 1and 1lateral 1aspect 1of 1the 1ankles 1are 1indicative 1of 1arterial
1
insufficiency
24. The 1nurse 1has 1just 1recorded 1a 1positive 1iliopsoas 1test 1on 1a 1patient 1who 1has 1abdominal
pain. 1This 1test 1is 1used 1to 1confirm 1a(n):
1
a. Inflamed 1liver.
b. Perforated 1spleen.
c. Perforated 1appendix.
d. Enlarged 1gallbladder.
ANS: 1C
An 1inflamed 1or 1perforated 1appendix 1irritates 1the 1iliopsoas 1muscle, 1producing 1pain 1in 1the 1RLQ.
25. The 1nurse 1will 1measure 1a 1patients 1near 1vision 1with 1which 1tool?
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b. Raynaud disease.
c. Chronic arterial insufficiency.
d. Chronic venous insufficiency.
d. 1 Ophthalmoscope
ANS: 1C
The 1Jaeger 1card 1is 1used 1to 1measure 1near 1vision
26. If 1the 1nurse 1records 1the 1results 1to 1the 1Hirschberg 1test, 1the 1nurse 1has:
a. Tested 1the 1patellar 1reflex.
b. Assessed 1for 1appendicitis.
c. Tested 1the 1corneal 1light 1reflex.
d. Assessed 1for 1thrombophlebitis.
ANS: 1C
The 1Hirschberg 1test 1assesses 1the 1corneal 1light 1reflex
27. During 1the 1examination 1of 1a 1patients 1mouth, 1the 1nurse 1observes 1a 1nodular 1bony 1ridge
down 1the 1middle 1of 1the 1hard 1palate. 1The 1nurse 1would 1chart 1this 1finding 1as:
1
a. Cheilosis.
b. Leukoplakia.
c. Ankyloglossia.
d. Torus 1palatinus.
ANS: 1D
A 1normal 1variation 1of 1the 1hard 1palate 1is 1a 1nodular 1bony 1ridge 1down 1the 1middle 1of 1the 1hard 1palate;
1
this 1variation 1is 1termed 1torus 1palatinus
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28. During examination, the nurse finds that a patient is unable to distinguish objects placed in
his hand. The nurse would document:
a. Stereognosis.
b. Astereognosis.
c. Graphesthesia.
d. Agraphesthesia.
ANS: 1B
Astereognosis 1is 1the 1inability 1to 1identify 1correctly 1an 1object 1placed 1in 1the 1hand
29. After 1the 1examination 1of 1an 1infant, 1the 1nurse 1documents 1opisthotonos. 1The 1nurse
recognizes 1that 1this 1finding 1often 1occurs 1with:
1
a. Cerebral 1palsy.
b. Meningeal 1irritation.
c. Lower 1motor 1neuron 1lesion.
d. Upper 1motor 1neuron 1lesion.
ANS: 1B
Opisthotonos 1is 1a 1form 1of 1spasm 1in 1which 1the 1head 1is 1arched 1back, 1and 1a 1stiffness 1of 1the 1neck
and 1an 1extension 1of 1the 1arms 1and 1legs 1are 1observed. 1Opisthotonus 1occurs 1with 1meningeal 1or
1
1
brainstem 1irritation
30. After 1assessing 1a 1female 1patient, 1the 1nurse 1notices 1flesh-colored, 1soft, 1pointed, 1moist,
papules 1in 1a 1cauliflower-like 1patch 1around 1her 1introitus. 1This 1finding 1is 1most 1likely:
1
a. Urethral 1caruncle.
b. Syphilitic 1chancre.
c. Herpes 1simplex 1virus.
d. Human 1papillomavirus.
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ANS: D
Human papillomavirus appears in a flesh-colored, soft, moist, cauliflower-like patch of pupils
31. While 1recording 1in 1a 1patients 1medical 1record, 1the 1nurse 1notices 1that 1a 1patients
Hematest 1results 1are 1positive. 1This 1finding 1means 1that 1there 1is(are):
1
a. Crystals 1in 1his 1urine.
b. Parasites 1in 1his 1stool.
c. Occult 1blood 1in 1his 1stool.
d. Bacteria 1in 1his 1sputum.
ANS: 1C
If 1a 1stool 1is 1Hematest 1positive, 1then 1it 1indicates 1the 1presence 1of 1occult 1blood
32. While 1examining 1a 148-year-old 1patients 1eyes, 1the 1nurse 1notices 1that 1he 1had 1to 1move
the 1handheld 1vision 1screener 1farther 1away 1from 1his 1face. 1The 1nurse 1would 1suspect:
1
a. Myopia.
b. Omniopia.
c. Hyperopia.
d. Presbyopia.
ANS: 1D
Presbyopia, 1the 1decrease 1in 1power 1of 1accommodation 1with 1aging, 1is 1suggested 1when 1the
1
handheld 1vision 1screener 1card 1is 1moved 1farther 1away
33. A 15-year-old 1child 1is 1in 1the 1clinic 1for 1a 1checkup. 1The 1nurse 1would 1expect 1him 1to:
a. Need 1to 1be 1held 1on 1his 1mothers 1lap.
b. Be 1able 1to 1sit 1on 1the 1examination 1table.
c. Be 1able 1to 1stand 1on 1the 1floor 1for 1the 1examination.
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d. Be able to remain alone in the examination room.
ANS: B
At 14 1or 15 1years 1old, 1a 1child 1usually 1feels 1comfortable 1on 1the 1examination 1table. 1Older 1infants 1and
1
young 1children 1aged 16 1months 1to 12 1or 13 1years 1should 1be 1positioned 1in 1the 1parents 1lap.
34. Which 1statement 1is 1true 1regarding 1the 1recording 1of 1data 1from 1the 1history 1and
physical 1examination?
1
a. Use 1long, 1descriptive 1sentences 1to 1document 1findings.
b. Record 1the 1data 1as 1soon 1as 1possible 1after 1the 1interview 1and 1physical 1examination.
c. If 1the 1information 1is 1not 1documented, 1then 1it 1can 1be 1assumed 1that 1it 1was 1done 1as
1a 1standard 1of 1care.
d. The 1examiner 1should 1avoid 1taking 1any 1notes 1during 1the 1history 1and
1examination 1because 1of 1the 1possibility 1of 1decreasing 1the 1rapport 1with 1the
1patient.
ANS: 1B
The 1data 1from 1the 1history 1and 1physical 1examination 1should 1be 1recorded 1as 1soon 1after 1the 1event
as 1possible. 1From 1a 1legal 1perspective, 1if 1it 1is 1not 1documented, 1then 1it 1was 1not 1done. 1Brief 1notes
1
1
should 1be 1taken 1during 1the 1examination. 1When 1documenting, 1the 1nurse 1should 1use 1short, 1clear
1
phrases 1and 1avoid 1redundant 1phrases 1and 1descriptions.
35. When 1assessing 1the 1neonate, 1the 1nurse 1should 1test 1for 1hip 1stability 1with 1which 1method?
a. Eliciting 1the 1Moro 1reflex
b. Performing 1the 1Romberg 1test
c. Checking 1for 1the 1Ortolani 1sign
d. Assessing 1the 1stepping 1reflex
ANS: 1C
The 1nurse 1should 1test 1for 1hip 1stability 1in 1the 1neonate 1by 1testing 1for 1the 1Ortolani 1sign. 1The
other 1tests 1are 1not 1appropriate 1for 1testing 1hip 1stability.
1
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36. A female patient tells the nurse that she has four children and has had three pregnancies.
How should the nurse document this?
a. Gravida 3, para 4
b. Gravida 14, 1para 13
c. This 1information 1cannot 1be 1documented 1using 1the 1terms 1gravida 1and 1para.
d. The 1patient 1seems 1to 1be 1confused 1about 1how 1many 1times 1she 1has 1been 1pregnant.
ANS: 1A
Gravida 1refers 1to 1the 1number 1of 1pregnancies, 1and 1para 1refers 1to 1the 1number 1of
37. The 1nurse 1is 1documenting 1the 1assessment 1of 1an 1infant. 1During 1the 1abdominal 1assessment,
the 1nurse 1noticed 1a 1very 1loud 1splash 1auscultated 1over 1the 1upper 1abdomen 1when 1the 1nurse
1
1
rocked 1her 1from 1side 1to 1side. 1This 1finding 1would 1indicate:
a. Epigastric 1hernia.
b. Pyloric 1obstruction.
c. Hypoactive 1bowel 1sounds.
d. Hyperactive 1bowel 1sounds.
ANS: 1D
A 1succussion 1splash, 1which 1is 1unrelated 1to 1peristalsis, 1is 1a 1very 1loud 1splash 1auscultated 1over
the 1upper 1abdomen 1when 1the 1infant 1is 1rocked 1side 1to 1side. 1It 1indicates 1increased 1air 1and 1fluid
1
1
in 1the 1stomach 1as 1observed 1with 1pyloric 1obstruction 1or 1large 1hiatus 1hernia
38. Which 1of 1these 1actions 1is 1most 1appropriate 1to 1perform 1on 1a 19-month-old 1infant 1at 1a 1wellchild 1checkup?
a. Testing 1for 1Ortolani 1sign
b. Assessment 1for 1stereognosis
c. Blood 1pressure 1measurement
d. Assessment 1for 1the 1presence 1of 1the 1startle 1reflex
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ANS: A
Until the age of 12 months, the infant should be assessed for Ortolani sign. If Ortolani sign is
present, then it could indicate the presence of a dislocated hip. The other tests are not appropriate
for 1a 19-month-old 1child.
Chapter 123 1Assessing 1Children: 1Infancy 1Through 1Adolescence
1Multiple 1Choice
1. During 1the 1delivery 1of 1a 1male 1infant, 1you 1are 1there 1to 1assess 1the 1Apgar 1score. 1He 1was 1born
1through 1an 1intact 1pelvis 1and 1had 1no 1complications 1during 1labor 1or 1delivery. 1At 11 1minute 1he 1is
1 pink 1all 1over 1and 1grimaces. 1He 1is 1flexing 1his 1arms 1and 1legs 1occasionally. 1He 1is 1breathing 1well
1and 1his 1heart 1rate 1is 1110. 1At 15 1minutes 1he 1is 1still 1pink 1all 1over 1but 1now 1is 1crying 1vigorously,
1with 1active 1movement. 1His 1respiratory 1effort 1is 1good 1and 1his 1heart 1rate 1is 1130.
What 1is 1his 1Apgar 1score?
A) 8 1at 11 1minute, 110 1at 15 1minutes
B) 7 1at 11 1minute, 1 9 1at 15 1minutes
C) 9 1at 11 1minute, 1 10 1at 15 1minutes
D) 8 1at 11 1minute, 19 1at 15 1minutes
Ans: 1A
Feedback: 1In 1checking 1the 1Apgar, 1five 1things 1are 1looked 1at 1during 1the 11-minute 1and 15-minute
1marks. 1The 1color, 1reflex 1irritability, 1muscle 1tone, 1respiratory 1effort, 1and 1heart 1rate 1are
1evaluated. 1In 1this 1case, 1at 11 1minute 1he 1received 12 1points 1for 1being 1pink 1all 1over, 11 1point 1for
1grimacing, 11 1point 1for 1flexion 1of 1the 1arms 1and 1legs, 12 1points 1for 1strong 1respiratory 1effort, 1and
12 1points 1for 1a 1heart 1rate 1over 1100. 1This 1gives 1a 11-minute 1total 1of 18. 1At 15 1minutes 1he 1was
1given 12 1points 1for 1being 1pink 1all 1over, 12 1points 1for 1vigorous 1crying, 12 1points 1for 1active
1movement, 12 1points 1for 1strong 1breathing, 1and 12 1points 1for 1a 1heart 1rate 1over 1100. 1This 1gives 1a
15-minute 1total 1of 110. 1These 1are 1normal, 1healthy 1Apgar 1scores.
2. A 124-year-old 1mother 1who 1is 1a 1smoker 1and 1cocaine 1addict 1gave 1birth 1at 139 1weeks 1to 1a
12,000- 1gram 1female 1infant 1who 1is 1in 1the 1neonatal 1intensive 1care 1unit. 1Using 1the 1Intrauterine
1Growth 1Curve 1chart, 1you 1determine 1whether 1the 1infant's 1weight 1is 1appropriate 1for 1her
1gestational 1age.
In 1which 1category 1does 1the 1infant 1best 1fit?
A) Large 1for 1gestational 1age
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B) Normal for gestational age
C) Small for gestational age
Ans: C
Feedback: 1For 1a 139-week 1infant, 1any 1weight 1less 1than 12,500 1grams 1would 1be 1considered 1small.
1Intrauterine 1growth 1retardation 1and 1low 1birth 1weight 1would 1be 1expected 1in 1a 1smoker 1who
1also 1abuses 1cocaine.
3. A 1mother 1brings 1her 116-month-old 1son 1in 1for 1an 1evaluation. 1She 1is 1afraid 1he 1is 1not 1meeting
1his 1developmental 1milestones 1and 1wants 1to 1know 1if 1he 1should 1be 1sent 1to 1therapy. 1He 1was 1the
1product 1of 1an 1uneventful 1pregnancy 1and 1a 1spontaneous 1vaginal 1delivery. 1His 1Apgar 1scores
1were 17 1and 19. 1Until 1reaching 1a 1year 1old 1the 1mother 1believes 1he 1was 1hitting 1his 1milestones
1appropriately. 1You 1decide 1to 1administer 1the 1Denver 1Developmental 1Screening 1Test. 1You 1find
1that 1he 1is 1using 1a 1 spoon 1to 1eat 1with 1and 1can 1take 1off 1his 1own 1shoes 1and 1shirt. 1He 1can 1build 1a
1tower 1of 1two 1cubes 1and 1dump 1raisins. 1His 1vocabulary 1consists 1of 1at 1least 110 1words. 1He 1can
1stand 1alone 1and 1stoop 1and 1recover, 1but 1he 1is 1unable 1to 1walk 1without 1holding 1onto 1someone's
1hand.
What 1type 1of 1developmental 1delay 1does 1he 1have?
A) Personal/social
B) Fine 1motor
C) Language
D) Gross 1motor
Ans: 1D
Feedback: 1 By 116 1months 1a 1child 1should 1be 1able 1to 1walk 1unaided 1and 1even 1walk 1backwards
1and 1run. 1This 1child 1was 1referred 1to 1physical 1therapy 1and 1did 1well.
4. A 1foster 1mother 1brings 1a 14-year-old 1child 1to 1see 1you 1for 1an 1evaluation. 1She 1has 1had 1custody
1of 1the 1girl 1for 12 1weeks. 1She 1knows 1that 1the 1child 1was 1born 1in 1your 1state 1and 1that 1her 1maternal
1grandmother 1had 1custody 1for 16 1months. 1She 1received 1good 1medical 1care 1during 1that 1time, 1but
1after 1her 1biologic 1mother 1obtained 1custody 1the 1child 1was 1abused 1and 1has 1had 1no 1further
1medical 1care. 1She 1says 1the 1child 1has 1had 1many 1behavioral 1problems 1and 1seems 1to 1be 1very
1behind 1on 1her 1developmental 1tasks. 1When 1you 1examine 1the 1child 1you 1notice 1short 1palpebral
1fissures, 1a 1wide 1nasal 1philtrum, 1and 1thin 1lips. 1Her 1cardiac, 1pulmonary, 1musculoskeletal, 1and
1abdominal 1examinations 1are 1normal. 1Her 1Denver 1Developmental 1Screening 1Test 1shows 1most
1of 1her 1milestones 1have 1occurred 1only 1through 1the 124th 1month.
What 1form 1of 1congenital 1retardation 1is 1she 1most 1likely 1to 1have?
A) Fetal 1alcohol 1syndrome
B) Congenital 1hypothyroidism
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C) Down syndrome
Ans: A
Feedback: The facial appearance in fetal alcohol syndrome shows short palpebral fissures, a
wide 1and 1flattened 1philtrum, 1and 1thin 1lips. 1These 1children 1often 1have 1mild 1retardation 1even
1with 1good 1care, 1but 1with 1abuse 1they 1may 1have 1more 1profound 1retardation. 1This 1condition
1may 1occur 1with 1only 1modest 1alcohol 1consumption.
5. A 1young 1Hispanic 1mother 1brings 1in 1her 12-month-old 1son. 1She 1is 1upset 1because 1her
1neighbors 1have 1threatened 1to 1call 1the 1Child 1Protective 1Agency 1because 1they 1think 1his
1birthmark 1is 1a 1bruise. 1Her 1son 1was 1the 1product 1of 1an 1uneventful 1pregnancy 1and 1spontaneous
1vaginal 1delivery. 1On 1examination 1you 1see 1a 1large, 1smooth-bordered 1bluish 1mark 1on 1his
1buttock 1and 1lower 1back. 1Otherwise 1his 1examination 1is 1unremarkable.
What 1form 1of 1birthmark 1is 1this 1likely 1to 1be?
A) Café-au-lait 1spot
B) Salmon 1patch
C) Mongolian 1spot
Ans: 1C
Feedback: 1 Mongolian 1spots 1are 1large, 1smooth-bordered 1birthmarks 1found 1on 1the 1back 1and/or
1buttocks. 1They 1are 1found 1more 1often 1in 1darker-pigmented 1infants 1such 1as 1in 1the 1Hispanic 1or
1Asian 1population. 1They 1are 1commonly 1mistaken 1for 1bruises.
6. A 132-year-old 1white 1female 1presents 1to 1labor 1and 1delivery 1fully 1effaced 1and 1delivers 1a 15.8lb 1(2,500-gram) 1infant 1female 1with 1Apgar 1scores 1of 16 1and 18. 1The 1mother 1has 1had 1no 1prenatal
1care 1and 1in 1the 1nursery 1you 1perform 1the 1newborn 1examination. 1With 1the 1Ballard 1scoring
1system, 1the 1neuromuscular 1examination 1score 1is 115. 1Looking 1at 1physical 1maturity, 1you 1see
1superficial 1peeling 1and 1few 1veins 1on 1the 1skin. 1The 1lanugo 1hair 1has 1bald 1areas 1and 1the 1plantar
1surface 1of 1the 1foot 1has 1creases 1on 1two 1thirds 1of 1it. 1The 1areola 1is 1stippled 1with 1a 12-mm 1bud.
1The 1pinna 1is 1well 1curved, 1is 1firm, 1and 1has 1instant 1recoil. 1The 1labia 1majora 1and 1minora 1are
1equally 1prominent.
Add 1the 1score 1of 1the 1neuromuscular 1components 1to 1your 1score 1of 1physical 1maturity 1to
1determine 1weeks 1of 1gestation. 1How 1many 1weeks 1of 1gestation 1has 1this 1child 1had?
A) 34 1weeks
B) 36 1weeks
C) 40 1weeks
Ans: 1B
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: Superficial peeling with few veins gives a score of 2 points; lanugo with balding
areas gives a score of 3 points; the plantar surface being covered by two thirds gives a score of 3
points; the stippled areola with a 2-mm bud gives a score of 2 points; the well-formed pinna with
instant recoil gives a score of 3 points. The equal labia majora and labia minora give a score of 2
points. Adding these numbers up gives a score of 15 points for physical maturity. Adding that to
the 115 1points 1for 1neuromuscular 1maturity 1gives 1a 1point 1total 1of 130, 1which 1correlates 1to 1a
1gestational 1age 1of 136 1weeks. 1This 1would 1be 1expected 1with 1a 1birth 1weight 1of 12,500 1grams.
7. A 1mother 1brings 1in 1her 13-year-old 1son 1for 1a 1well-child 1check-up. 1She 1is 1concerned 1that 1he
1seems 1different 1in 1size 1from 1all 1of 1the 1other 1preschool 1boys. 1He 1was 1the 1product 1of 1an
1uneventful 1pregnancy 1and 1vaginal 1delivery. 1He 1has 1hit 1all 1of 1his 1developmental 1milestones 1on
1time. 1On 1examination 1he 1is 126 1lbs 1(11.8 1kg) 1and 1is 135 1inches 1(89 1cm) 1tall. 1Otherwise 1his
1examination 1is 1unremarkable. 1You 1give 1the 1correct 1education 1for 1his 1age 1and 1then 1discuss 1his
1size.
For 1his 1age, 1what 1are 1his 1growth 1chart 1percentiles?
A) Tall 1and 1heavy 1for 1his 1age 1(>95%)
B) Average 1height 1and 1weight 1for 1his 1age 1(5 1to 195%)
C) Small 1and 1light 1for 1his 1age 1(<5%)
Ans: 1C
Feedback: 1According 1to 1the 1growth 1charts, 1this 1child 1is 1less 1than 1the 1fifth 1percentile 1for 1both
1height 1and 1weight, 1indicating 1that 1he 1is 1small 1and 1light 1for 1his 1age. 1This 1can 1be 1from 1a
1growth 1hormone 1deficiency 1but 1is 1usually 1due 1to 1genetic 1factors 1(such 1as 1short, 1light 1parents).
1It 1is 1most 1important 1to 1follow 1the 1trend 1of 1growth. 1It 1is 1more 1significant 1if 1this 1child 1was
1previously 1at 1the 150th 1percentile 1for 1height 1and 1weight 1than 1if 1he 1has 1always 1been 1about 1the
1same 1percentile 1and 1following 1a 1line 1parallel 1to 1expected 1growth 1lines.
8. A 1mother 1brings 1her 14-year-old 1daughter 1to 1your 1office 1because 1of 1fever 1and 1decreased
1eating 1and 1drinking. 1When 1you 1ask 1the 1little 1girl 1what 1is 1wrong, 1she 1says 1her 1mouth 1and
1throat 1hurt. 1On 1examination 1her 1temperature 1is 1101 1degrees. 1Her 1ears 1and 1nose 1examinations
1are 1unremarkable. 1Her 1mouth 1has 1ulcerations 1on 1the 1buccal 1mucosa 1and 1the 1tongue. 1She 1also
1has 1cervical 1lymphadenopathy. 1Her 1cardiac 1and 1pulmonary 1examinations 1are 1normal. 1She 1is 1up
1to 1date 1on 1her 1childhood 1vaccinations.
What 1mouth 1abnormality 1does 1she 1most 1likely 1have?
A) Strep 1throat
B) Herpetic 1stomatitis
C) Oral 1candidiasis 1(thrush)
D) Diphtheria
Ans: 1B
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Feedback: With herpetic stomatitis there is often a low-grade fever with small ulcers covering
the mucosa of the mouth. The pain from the ulcers leads to decreased oral intake and even
dehydration.
9. A 1mother 1brings 1her 115-month-old 1daughter 1to 1your 1office 1for 1evaluation 1of 1a 1rash 1and
1fever. 1She 1says 1the 1rash 1started 1one 1day 1and 1the 1fever 1developed 1the 1next 1day. 1Her 1daughter
1has 1had 1all 1of 1her 1vaccinations 1up 1to 110 1months. 1The 1mother 1sheepishly 1admits 1that 1she 1hasn't
1had 1time 1to 1bring 1her 1daughter 1in 1since 1her 110-month 1check-up. 1On 1examination 1you 1see 1a
1mildly 1sick- 1appearing 1toddler 1with 1a 1102-degree 1temperature. 1Looking 1at 1her 1skin 1you 1see 1at
1least 1100 1of 1a 1variety 1of 1papules, 1vesicles, 1and 1ulcers 1in 1different 1stages 1of 1development.
What 1illness 1prevented 1by 1proper 1vaccination 1does 1this 1toddler 1have?
A) Varicella 1(chickenpox)
B) Measles
C) Smallpox
Ans: 1A
Feedback: 1Normally 1the 1first 1vaccine 1for 1varicella 1is 1given 1at 112 1to 115 1months. 1The
1characteristic 1rash 1in 1waves 1of 1lesions 1is 1in 1a 1pattern 1of 1papules, 1vesicles, 1ulcers, 1and 1scabs.
1Because 1of 1the 1number 1of 1persons 1who 1still 1get 1shingles 1(an 1outbreak 1of 1varicella 1in 1one
1dermatome 1following 1the 1original 1infection 1by 1years), 1there 1is 1still 1enough 1virus 1in 1the 1United
1States 1to 1easily 1get 1chickenpox 1without 1vaccination. 1This 1child 1is 1regarded 1as 1contagious 1to
1others 1until 1all 1of 1the 1lesions 1are 1―scabbed 1over.‖ 1 Smallpox 1would 1appear 1different 1in 1that 1all
1of 1the 1lesions 1would 1be 1in 1the 1same 1stage 1of 1development.
10. An 1adolescent 1male 1comes 1to 1your 1clinic 1with 1a 1note 1from 1his 1mother 1stating 1it 1is 1okay 1for
1him 1to 1be 1seen 1today 1without 1her 1presence. 1He 1has 1come 1in 1for 1his 1annual 1sports 1physical
1required 1to 1play 1football. 1For 1his 1age 1his 1physical 1examination 1is 1unremarkable 1and 1you 1sign
1his 1school's 1physical 1examination 1form. 1You 1decide 1to 1take 1this 1opportunity 1to 1do 1some 1health
1education 1with 1him. 1He 1admits 1to 1wondering 1a 1lot 1lately 1if 1he 1is 1normal. 1Although 1he 1is 1in
1football 1he 1really 1enjoys 1science 1and 1computers 1more. 1He 1is 1worried 1that 1all 1his 1buddies 1will
1think 1he 1is 1a 1geek. 1He 1is 1convinced 1he 1also 1won't 1get 1a 1date 1for 1the 1Sadie 1Hawkins 1dance 1next
1week 1because 1the 1girls 1all 1think 1he 1is 1boring, 1too. 1He 1denies 1any 1experimentation 1with 1tobacco
1or 1alcohol, 1and 1he 1blushes 1when 1you 1mention 1sex. 1After 1hitting 1all 1the 1pertinent 1ageappropriate 1education 1points 1you 1give 1him 1his 1sports 1physical 1form 1and 1he 1leaves.
The 1patient's 1concerns 1during 1the 1visit 1most 1resemble 1what 1developmental 1stage 1of 1adolescence?
A) Early 1adolescence 1(10 1to 114 1years 1old)
B) Middle 1adolescence 1(15 1to 116 1years 1old)
C) Late 1adolescence 1(17 1to 120 1years 1old)
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Ans: A
Feedback: His concern with whether he is normal or not is often seen in the development of
social identity in early adolescence. He is also concerned with the present (Sadie Hawkins dance)
and not the distant future, as is seen with late adolescence. He also denies the experimentation
often 1seen 1in 1middle 1adolescence.
11. A 138-week 1gestation, 12500-gram 1infant 1is 1placed 1on 1your 1service. 1 How 1would 1she
1be 1described?
A) Term, 1normal 1birth 1weight
B) Term, 1low 1birth 1weight
C) Preterm, 1normal 1birth 1weight
D) Preterm, 1low 1birth 1weight
Ans: 1A
Feedback: 1 Preterm 1is 1defined 1as 1less 1than 137 1weeks; 1term, 137–42 1weeks; 1and 1post-term, 1over
142 1weeks 1of 1gestation. 1Birth 1weights 1have 1similar 1limits: 1 extremely 1low 1birth 1weight, 1less
1than 11000 1grams; 1very 1low 1birth 1weight, 1less 1than 11500 1grams; 1low 1birth 1weight, 1less 1than
12500 1grams; 1and 1normal 1birth 1weight, 1equal 1to 1or 1more 1than 12500 1grams. 1These 1have
1prognostic 1implications 1and 1impact 1on 1how 1closely 1to 1watch 1and 1how 1aggressively 1to 1treat
1these 1infants.
12. You 1are 1observing 1an 1infant 1who 1is 1able 1to 1pull 1to 1a 1stand, 1uses 1―mama‖ 1and 1―dada‖
1specifically, 1and 1indicates 1his 1wants 1by 1vocalization 1and 1pointing. 1Where 1would 1you 1place
1this 1child's 1developmental 1age?
A) 12 1months
B) 10 1months
C) 8 1months
D) 6 1months
Ans: 1C
Feedback: 1Assessing 1developmental 1milestones 1is 1of 1major 1importance 1during 1the 1first 1year
1and 1beyond. 1These 1accomplishments 1in 1the 1physical, 1cognitive/language, 1and 1social 1domains
1are 1normal 1for 1an 18-month-old 1infant.
13. Which 1of 1the 1following 1will 1help 1to 1optimize 1yield 1from 1a 1pediatric 1examination?
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
A) Doing the examination out of order if necessary to take advantage of quiet periods for
auscultation, etc.
B) Being very orderly, so as not to miss a portion of the examination
C) Using firmness as needed to make it through your examination
D) Making sure to place the infant on the table during the examination while mom watches
close 1by
Ans: 1A
Feedback: 1While 1order 1and 1routine 1are 1comforting 1to 1the 1examiner, 1children 1should 1be
1examined 1in 1an 1order 1which 1allows 1maximum 1yield. 1Many 1prefer 1to 1listen 1to 1the 1heart 1and
1lungs 1first 1while 1the 1child 1is 1quiet, 1in 1a 1parent's 1arms. 1Likewise, 1you 1may 1gain 1advantage 1to
1examining 1the 1mouth 1while 1the 1baby 1is 1crying. 1Most 1view 1the 1ENT 1examination 1as 1the 1most
1invasive 1for 1a 1child 1(especially 1the 1otoscopic 1examination), 1so 1many 1leave 1this 1for 1last.
14. A 16-month-old 1infant 1is 1brought 1in 1for 1a 1well 1check. 1It 1is 1noted 1his 1head 1circumference 1is
1off 1the 1chart 1and 1at 1a 1much 1higher 1percentile 1than 1was 1previously 1measured. 1What 1should 1you
1do 1next?
A) Recommend 1a 1neurology 1consult.
B) Order 1a 1CT 1of 1the 1head.
C) Remeasure 1the 1circumference.
D) Admit 1the 1child 1to 1the 1hospital 1for 1further 1workup.
Ans: 1C
Feedback: 1It 1is 1difficult 1to 1obtain 1accurate 1measurements 1of 1a 1squirming 1infant. 1The 1first 1step
1would 1be 1to 1remeasure. 1Some 1recommend 1starting 1with 1three 1measurements 1and 1averaging 1or
1picking 1the 1middle 1measurement. 1Height 1is 1technically 1not 1measured 1until 1a 1child 1is 1standing,
1so 1infants' 1measurements 1are 1recorded 1as 1length.
15. You 1are 1examining 1an 1infant 1in 1the 1nursery 1and 1notice 1a 1soft 1bump 1over 1the 1posterior
1right 1side 1of 1the 1skull. 1 It 1is 1not 1evident 1on 1the 1left. 1 What 1does 1this 1represent?
A) Caput 1succedaneum
B) Plagiocephaly
C) Craniosynostosis
D) Cephalohematoma
Ans: 1D
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
Feedback: Cephalohematoma represents bleeding under the periosteum, which is why this lesion
does not cross the midline. The blood can contribute to neonatal jaundice as it breaks down.
Caput succedaneum is commonly seen as a spongy mass over the vertex, particularly when
vacuum extraction is used. Craniosynostosis describes a premature closure of bony skull sutures,
and plagiocephaly is a flattening of the parieto-occipital region on one side of the skull, which is
frequently 1thought 1to 1be 1positional.
16. You 1are 1assessing 1an 1infant 1and 1notice 1that 1his 1nares 1flare, 1he 1has 1a 1soft 1grunt 1with 1each
1breath, 1and 1the 1skin 1between 1his 1ribs 1is 1pulled 1inward 1with 1inhalation. 1What 1is 1the
1significance 1of 1these 1findings?
A) These 1are 1indicative 1of 1a 1CNS 1process.
B) These 1are 1indicative 1of 1respiratory 1distress.
C) These 1are 1indicative 1of 1muscular 1dystrophy.
D) These 1are 1frequently 1accompanied 1by 1stridor.
Ans: 1B
Feedback: 1It 1is 1critical 1to 1notice 1these 1findings 1of 1respiratory 1distress. 1Muscular 1dystrophy
1may 1not 1allow 1the 1appearance 1of 1these 1signs 1because 1they 1are 1caused 1by 1muscular 1effort. 1It 1is
1hard 1to 1find 1a 1cause 1for 1these 1signs 1in 1the 1CNS. 1Stridor 1is 1usually 1inspiratory, 1so 1while 1nasal
1flaring 1and 1retractions 1may 1occur, 1grunting 1is 1unusual 1because 1exhalation 1is 1unimpeded.
17. A 1mother 1brings 1her 1infant 1to 1you 1because 1of 1a 1―rattle‖ 1in 1his 1chest 1with 1breathing. 1Which
1of 1the 1following 1would 1you 1hear 1if 1there 1were 1a 1problem 1in 1the 1upper 1airway?
A) Different 1sounds 1from 1the 1nose 1and 1chest
B) Asymmetric 1sounds
C) Inspiratory 1sounds
D) Sounds 1louder 1in 1the 1lower 1chest
Ans: 1C
Feedback: 1It 1is 1important 1to 1distinguish 1upper 1airway 1sounds 1from 1lower 1because 1many 1benign
1conditions 1cause 1upper 1airway 1noise, 1such 1as 1viral 1upper 1respiratory 1infections. 1It 1is 1reassuring
1to 1hear 1the 1same 1noises 1at 1the 1nose 1as 1at 1the 1chest. 1Lower 1respiratory 1conditions 1also 1are
1generally 1symmetric, 1and 1sounds 1are 1louder 1at 1the 1upper 1chest 1versus 1the 1lower 1chest. 1 They
1are 1usually 1very 1harsh 1and 1loud, 1which 1concerns 1parents.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
18. An infant presents with a heart rate of 180, a respiratory rate of 68, and an enlarged liver.
What diagnosis does this suggest?
A) Pneumonia
B) Heart failure
C) Sepsis
D) 1Necrotizing 1enterocolitis
Ans: 1B
Feedback: 1Heart 1failure 1presents 1differently 1in 1infants 1than 1in 1adults. 1This 1triad 1should 1suggest
1this 1diagnosis. 1Pneumonia, 1necrotizing 1enterocolitis, 1and 1sepsis 1should 1not 1necessarily 1cause
1hepatomegaly. 1Observe 1closely 1for 1central 1cyanosis 1of 1the 1lips 1and 1tongue. 1Peripheral
1cyanosis 1alone 1does 1not 1mean 1much 1in 1infants. 1Perform 1a 1careful 1cardiac 1examination 1in 1as
1quiet 1a 1setting 1as 1possible, 1perhaps 1while 1the 1infant 1is 1in 1the 1mother's 1arms, 1to 1look 1for
1evidence 1of 1valvular 1disease.
19. You 1have 1been 1unable 1to 1hear 1normal 1S2 1 splitting 1in 1children 1up 1to 1this 1point.
1 What 1technique 1will 1maximize 1your 1chances 1of 1hearing 1this 1phenomenon?
A) Listen 1with 1the 1diaphragm 1over 1the 1left 1lower 1sternal 1border.
B) Listen 1with 1the 1bell 1over 1the 12nd 1left 1intercostal 1space.
C) Listen 1with 1the 1bell 1over 1the 1apex.
D) Listen 1with 1the 1diaphragm 1in 1the 1axilla.
Ans: 1B
Feedback: 1 S2 1 is 1made 1of 1aortic 1and 1pulmonic 1components. 1 Of 1these, 1the 1pulmonic 1component 1is
1much 1softer 1and 1heard 1best 1over 1the 1pulmonic 1area. 1Even 1in 1the 1proper 1location, 1the 1pulmonic
1component 1may 1be 1difficult 1to 1hear 1with 1the 1diaphragm 1because 1it 1is 1a 1soft, 1low-pitched 1sound.
For 1this 1reason, 1the 1bell 1should 1be 1used 1to 1listen 1for 1S2 1splitting 1over 1the 1pulmonic 1area 1during
1inspiration, 1when 1splitting 1should 1be 1maximized. 1Breathing 1also 1changes 1heart 1rate 1more
1rapidly 1in 1children. 1One 1may 1think 1an 1arrhythmia 1is 1present 1until 1she 1notices 1that 1this 1rate
1change 1is 1related 1to 1the 1respiratory 1cycle.
20. A 1mother 1is 1upset 1because 1she 1was 1told 1by 1another 1provider 1that 1her 1child 1has 1a
1worrisome 1murmur. 1You 1listen 1near 1the 1clavicle 1and 1notice 1both 1a 1systolic 1and 1diastolic
1sound. 1You 1remember 1that 1diastolic 1murmurs 1are 1usually 1indicative 1of 1bad 1pathology. 1What
1would 1you 1do 1next?
A) Cardiology 1referral
B) Echocardiogram
C) Supine 1examination
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
D) Reassure the mother
Ans: C
Feedback: The next step would be to examine the patient in the supine position. If this is a
venous 1hum, 1this 1murmur 1will 1resolve 1almost 1completely 1in 1the 1supine 1position. 1This 1is 1a
1very 1common 1phenomenon 1in 1school-aged 1children, 1particularly 1over 1the 1clavicle, 1but 1can 1also
1occur 1outside 1this 1range. 1Reassurance 1cannot 1be 1given 1without 1further 1examination,
1especially 1with 1a 1diastolic 1murmur. 1Cardiology 1referral 1and 1echocardiography 1are
1unnecessary 1if 1examination 1in 1the 1supine 1position 1reveals 1no 1murmur.
21. A 1toddler 1is 1able 1to 1jump 1in 1place 1and 1balance 1on 1one 1foot 1as 1well. 1She 1can 1also 1speak 1in
1full 1sentences 1and 1feed 1herself. 1 What 1is 1the 1approximate 1developmental 1age 1of 1this 1child?
A) 2 1years
B) 3 1years
C) 4 1years
D) 5 1years
Ans: 1B
Feedback: 1 These 1milestones 1are 1consistent 1with 1a 1physical, 1cognitive/language, 1and 1social 1and
1emotional 1developmental 1age 1of 13 1years.
22. You 1are 1having 1trouble 1examining 1the 1abdomen 1of 1a 1school-aged 1child 1due 1to
1ticklishness. 1What 1should 1you 1do?
A) Have 1the 1child 1press 1on 1your 1hand.
B) Have 1the 1parent 1insist 1that 1the 1child 1allow 1you 1to 1examine 1her.
C) Ask 1the 1parent 1to 1leave 1the 1room.
D) Make 1the 1child 1realize 1that 1this 1is 1part 1of 1the 1examination 1and 1must 1be 1done.
Ans: 1A
Feedback: 1By 1having 1the 1child 1participate 1in 1the 1examination 1and 1pressing 1on 1your 1hand, 1it
1will 1eliminate 1the 1ticklishness. 1Resistance 1to 1examination 1at 1this 1age 1is 1normal. 1 The 1last
1three 1options 1only 1make 1the 1situation 1worse. 1The 1key 1is 1to 1have 1the 1child 1participate 1in 1the
1examination 1in 1a 1fun 1way.
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
23. You are examining a 5-year-old before he begins school. You notice a systolic, grade II/VI
vibratory murmur over the LLSB and apex with normal S2 splitting. He has normal pulses as
well. Which of the following is most likely?
A) Tricuspid stenosis
B) Mitral stenosis
C) Still's 1murmur
D) Venous 1hum
Ans: 1C
Feedback: 1This 1description 1is 1consistent 1with 1Still's 1murmur, 1a 1very 1common 1and 1benign
1murmur 1of 1childhood. 1Tricuspid 1and 1mitral 1stenosis 1would 1be 1diastolic 1murmurs 1and 1the
1venous 1hum 1is 1usually 1not 1heard 1in 1this 1area. 1 Further 1evaluation 1is 1usually 1not 1necessary.
24. You 1are 1going 1to 1obtain 1a 1social 1history 1on 1an 1early 1adolescent 1boy. 1How 1should
1you 1proceed 1to 1obtain 1the 1best 1information?
A) Ask 1his 1mother 1to 1leave 1the 1room.
B) Ask 1if 1he 1would 1prefer 1his 1mother 1to 1leave 1the 1room.
C) Ask 1your 1questions 1with 1his 1mother 1in 1the 1room.
D) Ask 1his 1mother 1how 1she 1would 1like 1to 1proceed.
Ans: 1B
Feedback: 1It 1is 1best 1to 1ask 1the 1patient 1what 1he 1or 1she 1would 1prefer. 1Because 1the 1examination
1should 1include 1a 1genitalia 1examination, 1some 1children 1in 1early 1adolescence 1are 1more
1comfortable 1with 1their 1parents 1in 1the 1room. 1Some 1examiners 1will 1provide 1―confidential 1time‖
1to 1both 1the 1adolescent 1and 1the 1parent, 1so 1that 1parental 1concerns 1can 1also 1be 1adequately
1addressed. 1Leaving 1the 1parent 1in 1the 1room 1without 1asking 1the 1adolescent 1is 1usually 1not 1a 1good
1idea 1and 1can 1limit 1optimal 1history 1gathering 1and 1examination.
25. You 1are 1assessing 1Tanner 1staging 1of 1the 1breast 1in 1a 1young 1woman. 1You 1notice 1projection
1of 1the 1areola 1and 1nipple 1to 1form 1a 1secondary 1mound 1above 1the 1level 1of 1the 1breast. 1Which
1Tanner 1stage 1would 1this 1be?
A) I
B) II
C) III
D) IV
Ans: 1C
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Feedback: This would be a Tanner stage III because there is elevation of the nipple and areola
above the level of the surrounding breast tissue and because the areola has not receded to the
general contour of the breast.
26. A 1quiet 13-year-old 1is 1brought 1in 1for 1a 1routine 1check-up 1when 1you 1notice 1a 1fresh 1bruise 1in
1the 1axilla 1and 1bilateral 1bruises 1over 1the 1upper 1back 1that 1appear 1slightly 1older. 1There 1are
1brown 1bruises 1over 1his 1shins 1as 1well. 1His 1mother 1said 1this 1happened 1when 1he 1fell 1off 1of 1a
1couch. 1What 1diagnosis 1should 1be 1considered?
A) Von 1Willebrand's 1disease
B) Normal 1childhood 1bruises 1from 1activity
C) Abuse
D) Seizure 1disorder
Ans: 1C
Feedback: 1No 1one 1wants 1to 1think 1that 1a 1child 1could 1be 1abused. 1 In 1this 1case 1the 1bruises 1on 1the
1shins 1are 1very 1normal 1for 1this 1age 1group 1with 1normal 1activity. 1The 1presence 1of 1bruises 1in
1other 1areas 1which 1do 1not 1correlate 1with 1the 1given 1history 1are 1important 1to 1notice 1and 1should
1make 1you 1consider 1this 1diagnosis. 1A 1very 1thorough 1examination 1must 1be 1conducted 1to 1search
1for 1other 1lesions 1that 1might 1be 1consistent 1with 1the 1use 1of 1implements 1such 1as 1an 1electrical
1cord, 1clothes 1iron, 1cigarette, 1etc. 1A 1social 1services 1consult 1and/or 1formal 1abuse 1evaluation
1should 1be 1considered. 1Unfortunately, 1emotional 1and 1sexual 1abuse 1do 1not 1frequently 1leave
1outward 1signs. 1It 1is 1important 1to 1keep 1an 1open 1mind 1to 1the 1presence 1of 1these 1other 1types 1of
1abuse 1as 1well.
27. A 115-month-old 1is 1brought 1to 1you 1for 1a 1fever 1of 138.6 1degrees 1Celsius 1and 1fussiness. 1The
1ear 1examination 1is 1as 1follows: 1external 1ear, 1normal 1appearance 1and 1no 1tenderness 1with
1manipulation; 1canal, 1normal 1diameter 1without 1evidence 1of 1inflammation; 1tympanic 1membrane,
1bulging, 1erythematous, 1and 1opaque. 1 Insufflation 1is 1deferred 1due 1to 1pain. 1 What 1is 1your
1diagnosis?
A) Otitis 1externa
B) Cholesteatoma
C) Ruptured 1tympanic 1membrane
D) Otitis 1media
Ans: 1D
Feedback: 1There 1is 1no 1inflammation 1of 1the 1outer 1ear, 1including 1the 1canal, 1thus 1excluding 1otitis
1externa. 1 Cholesteatoma 1is 1a 1painless 1white 1lesion 1behind 1the 1TM. 1 There 1is 1no 1drainage 1from 1the
1TM; 1thus, 1rupture 1is 1unlikely. 1This 1is 1a 1classic 1description 1of 1otitis 1media. 1Many 1examiners 1will
1forego 1insufflation 1if 1the 1diagnosis 1is 1clear, 1because 1this 1can 1cause 1discomfort 1in 1an 1already
1uncomfortable 1ear.
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Chapter 24 Assessing Older Adults
Multiple Choice
1. Which 1of 1the 1following 1changes 1are 1expected 1in 1vision 1as 1part 1of 1the 1normal 1aging 1process?
A) Cataracts
B) Glaucoma
C) Macular 1degeneration
D) Blurring 1of 1near 1vision
Ans: 1D
Feedback: 1The 1lens 1loses 1its 1elasticity 1over 1time 1as 1part 1of 1the 1normal 1aging 1process, 1and 1the
1eye 1is 1less 1able 1to 1accommodate 1and 1focus 1on 1near 1objects; 1therefore, 1the 1patient 1will 1be
1expected 1to 1have 1blurring 1of 1near 1vision.
2. A 172-year-old 1retired 1truck 1driver 1comes 1to 1the 1clinic 1with 1his 1wife 1for 1evaluation 1of
1hearing 1loss. 1He 1has 1noticed 1some 1decreased 1ability 1to 1hear 1what 1his 1wife 1and 1grandchildren
1are 1saying 1to 1him. 1He 1admits 1to 1lip-reading 1more. 1He 1has 1a 1history 1of 1noise 1exposure 1in 1his
1young 1adult 1years: 1He 1worked 1as 1a 1sound 1engineer 1at 1a 1local 1arena 1and 1had 1to 1attend 1a 1lot 1of
1concerts. 1Based 1on 1this 1information, 1what 1is 1the 1most 1likely 1finding 1regarding 1his 1hearing
1acuity?
A) Loss 1of 1acuity 1for 1middle-range 1sounds
B) Increase 1of 1acuity 1for 1low-range 1sounds
C) Loss 1of 1acuity 1for 1high-range 1sounds
D) Increase 1of 1acuity 1for 1high-range 1sounds
Ans: 1A
Feedback: 1Human 1speech 1is 1considered 1to 1be 1a 1middle-range 1sound. 1During 1the 1aging 1process
1there 1is 1a 1loss 1of 1acuity, 1starting 1with 1high-pitched 1sounds 1but 1extending 1to 1the 1middle 1range
1and 1then 1into 1the 1low 1range.
3. A 179-year-old 1retired 1banker 1comes 1to 1your 1office 1for 1evaluation 1of 1difficulty 1with
1urination; 1he 1gets 1up 1five 1to 1six 1times 1per 1night 1to 1urinate 1and 1has 1to 1go 1at 1least 1that 1often 1in
1the 1daytime. 1He 1does 1not 1feel 1as 1if 1his 1bladder 1empties 1completely; 1the 1strength 1of 1the 1urinary
1stream 1is 1diminished. 1He 1denies 1dysuria 1or 1hematuria. 1This 1problem 1has 1been 1present 1for
1several 1years 1but 1has 1worsened 1over 1the 1last 18 1months. 1You 1palpate 1his 1prostate. 1What 1is 1your
1expected 1physical 1examination 1finding, 1based 1on 1this 1description?
A) Normal 1size, 1smooth
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B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy
Ans: C
Feedback: 1This 1is 1the 1expected 1physical 1examination 1finding 1in 1benign 1prostatic 1hyperplasia
1(BPH).
4. A 170-year-old 1retired 1auto 1mechanic 1comes 1to 1your 1office 1because 1his 1neighbor 1is
1concerned 1about 1his 1memory. 1The 1patient 1himself 1admits 1to 1misplacing 1his 1keys 1more 1often
1and 1forgets 1what 1he 1is 1supposed 1to 1buy 1from 1the 1grocery 1store 1and 1where 1he 1has 1parked 1the
1car. 1He 1denies 1getting 1lost 1in 1familiar 1places. 1Upon 1further 1questioning, 1he 1states 1that 1his 1wife
1of 140 1years 1died 18 1months 1ago; 1his 1three 1children 1live 1in 1three 1different 1states; 1and 1he 1has
1limited 1his 1activities 1because 1the 1people 1he 1interacted 1with 1were 1―his 1wife's 1friends, 1not 1his.‖
1He 1drinks 1a 1six-pack 1of 1beer 1daily; 1he 1does 1not 1smoke 1or 1use 1illicit 1drugs. 1You 1perform 1a
1mini-mental 1state 1examination 1and 1obtain 1a 1total 1score 1of 124 1out 1of 128. 1Based 1on 1this
1information, 1what 1is 1your 1most 1likely 1diagnosis?
A) Benign 1forgetfulness
B) Dementia
C) Meningitis
D) Depression
Ans: 1D
Feedback: 1The 1patient 1has 1symptoms 1of 1depression: 1His 1wife 1died, 1he 1has 1no 1real 1social
1support 1system, 1and 1he 1has 1isolated 1himself 1from 1his 1usual 1activities. 1He 1also 1drinks 1a
1considerable 1amount 1of 1alcohol 1on 1a 1daily 1basis, 1which 1can 1further 1depress 1his 1mood.
1Depression 1can 1masquerade 1as 1dementia 1in 1the 1elderly 1and 1must 1be 1considered 1in 1a 1patient
1with 1memory 1loss.
5. An 185-year-old 1retired 1teacher 1comes 1to 1your 1office 1for 1evaluation 1of 1weakness. 1You 1obtain
1a 1complete 1history, 1perform 1a 1thorough 1physical 1examination, 1and 1order 1laboratory 1tests. 1You
1diagnose 1her 1with 1hyperthyroidism. 1Based 1on 1her 1age, 1which 1of 1the 1atypical 1symptoms 1of
1hyperthyroidism 1is 1more 1likely 1to 1be 1seen?
A) Fatigue
B) Weight 1loss
C) Tachycardia
D) Anorexia
Ans: 1D
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Feedback: This is an atypical symptom of hyperthyroidism that is more likely to be seen in the
older patient.
6. A 178-year-old 1retired 1seamstress 1comes 1to 1the 1office 1for 1a 1routine 1check-up. 1You 1obtain 1an
1ECG 1(electrocardiogram) 1because 1of 1her 1history 1of 1hypertension. 1You 1diagnose 1a 1previous
1myocardial 1infarction 1and 1ask 1her 1if 1she 1had 1any 1symptoms 1related 1to 1this. 1Which 1of 1the
1following 1symptoms 1would 1be 1more 1common 1in 1this 1patient's 1age 1group 1for 1an 1acute
1myocardial 1infarction?
A) Chest 1pain
B) Syncope
C) Pain 1radiating 1into 1the 1left 1arm
D) Pain 1radiating 1into 1the 1jaw
Ans: 1B
Feedback: 1 This 1is 1an 1atypical 1symptom 1and 1more 1likely 1to 1be 1seen 1in 1this 1patient's 1age 1group.
7. An 188-year-old 1retired 1piano 1teacher 1comes 1for 1evaluation 1of 1fatigue. 1You 1notice 1that 1her
1clothes 1are 1hanging 1loosely 1off 1her 1frame 1and 1that 1she 1has 1lost 115 1pounds. 1She 1is 1unaware 1of
1this. 1Her 1husband 1of 163 1years 1died 1a 1few 1months 1ago. 1You 1ask 1the 1patient 1to 1complete 1a 1Rapid
1Screen 1for 1Dietary 1Intake. 1Which 1of 1the 1following 1statements 1is 1considered 1to 1be 1part 1of 1this
1rapid 1screen?
A) I 1eat 1more 1than 1two 1meals 1per 1day.
B) I 1drink 1one 1glass 1of 1alcohol 1every 1day.
C) Without 1wanting 1to, 1I 1have 1lost 1or 1gained 110 1pounds 1in 1the 1last 16 1months.
D) I 1eat 1with 1at 1least 1one 1other 1person 1most 1of 1the 1time.
Ans: 1C
Feedback: 1 This 1is 1part 1of 1the 1Rapid 1Screen 1for 1Dietary 1Intake.
8. An 189-year-old 1retired 1school 1principal 1comes 1for 1an 1annual 1check-up. 1She 1would 1like 1to
1know 1whether 1or 1not 1she 1should 1undergo 1a 1screening 1colonoscopy. 1She 1has 1never 1done 1this
1before. 1Which 1of 1the 1following 1factors 1should 1not 1be 1considered 1when 1discussing 1whether
1she 1should 1go 1for 1this 1screening 1test?
A) Life 1expectancy
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B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient
Ans: D
Feedback: 1The 1current 1age 1of 1the 1patient 1is 1not 1as 1important 1as 1her 1actual 1life 1expectancy 1and
1current 1health 1status.
9. Which 1of 1the 1following 1booster 1immunizations 1is 1recommended 1in 1the 1older 1adult 1population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps
Ans: 1A
Feedback: 1Older 1adults 1who 1have 1received 1the 1primary 1series 1of 1three 1tetanus 1immunizations
1should 1receive 1the 1single 1booster 1dose 1of 1tetanus 1immunization 1every 110 1years.
10. You 1are 1asked 1to 1perform 1a 1home 1safety 1assessment 1for 1an 187-year-old 1retired 1farmer
1who 1lives 1by 1himself. 1Which 1of 1the 1following 1is 1not 1considered 1to 1be 1an 1increased 1risk 1for
1falls?
A) Loose 1electrical 1cords
B) Slippery 1or 1irregular 1surfaces
C) Chairs 1at 1awkward 1angles
D) Bright 1lighting
Ans: 1D
Feedback: 1Bright 1lighting 1is 1a 1recommendation 1to 1improve 1an 1older 1person's 1ability 1to 1see 1all
1possible 1things 1that 1could 1result 1in 1a 1fall.
11. A 173-year-old 1retired 1accountant 1comes 1to 1your 1office 1for 1her 1annual 1examination. 1She
1has 1incontinence 1of 1urine 1when 1she 1coughs 1or 1sneezes. 1She 1takes 1several 1medications 1for
1control 1of 1hypertension 1and 1diabetes. 1You 1use 1the 1DIAPERS 1mnemonic 1to 1assess 1the 1cause
1of 1her 1incontinence. 1All 1of 1the 1following 1are 1items 1represented 1by 1the 1mnemonic 1except 1for:
A) Atrophic 1vaginitis
B) Depression
C) Pharmaceuticals
D) Restricted 1mobility
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Ans: B
Feedback: Depression is not a risk factor for incontinence. The D in the mnemonic stands for
delirium.
12. Which 1of 1the 1following 1brief 1screening 1measures 1is 1useful 1in 1assessing 1memory?
A) Three-item 1recall
B) Serial 17s
C) Spelling 1―world‖ 1backward
D) Copying 1intersecting 1pentagrams
Ans: 1A
Feedback: 1 If 1the 1patient 1is 1unable 1to 1remember 1three 1items 1after 11 1minute 1has 1passed, 1then 1this
1is 1a 1positive 1screening 1test 1and 1indicates 1a 1need 1for 1further 1testing. 1This 1is 1part 1of 1the 1―10Minute 1Geriatric 1Screener.‖
13. Which 1of 1the 1following 1questions 1is 1part 1of 1the 1screening 1for 1physical 1disability?
A) Are 1you 1able 1to 1go 1shopping 1for 1groceries 1or 1clothes?
B) Are 1you 1able 1to 1walk 1one 1block?
C) Are 1you 1able 1to 1pass 1the 1driver's 1license 1test?
D) Are 1you 1able 1to 1perform 1light 1dusting 1and 1pick 1up 1after 1yourself 1around 1the 1house?
Ans: 1A
Feedback: 1This 1is 1part 1of 1the 1Physical 1Disability 1screening 1portion 1of 1the 110-Minute 1Geriatric
1Screener.
14. It 1is 1summer 1and 1an 182-year-old 1woman 1is 1brought 1to 1you 1from 1her 1home 1after 1seeing 1her
1primary 1care 1doctor 12 1days 1ago. 1She 1was 1started 1on 1an 1antibiotic 1at 1that 1time. 1 Today, 1she
1comes 1to 1the 1emergency 1room 1not 1knowing 1where 1she 1is 1or 1what 1year 1it 1is. 1What 1could 1be 1a
1likely 1cause 1of 1this?
A) Alzheimer's 1dementia
B) Stroke
C) Delirium
D) Meningitis
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Ans: C
Feedback: These are not signs of normal aging and seem to be of acute onset. This makes
Alzheimer's less likely. Stroke and meningitis could cause these symptoms as well, but the
combination of the heat and a recent infection make delirium much more likely. Though she was
prescribed an antibiotic, she may not have improved because of bacterial resistance or because of
noncompliance 1due 1to 1cost, 1depression, 1or 1even 1an 1underlying 1mild 1dementia. 1Dementia
1should 1not 1result 1in 1an 1acute 1mental 1status 1change, 1although 1illness 1may 1cause 1a 1worsening 1of
1dementia.
15. Blood 1pressure 1abnormalities 1found 1more 1commonly 1in 1Western 1elderly 1include 1which 1of
1the 1following?
A) Isolated 1elevation 1of 1the 1diastolic 1BP
B) Narrow 1pulse 1pressure
C) Elevation 1of 1the 1systolic 1BP
D) Elevation 1of 1the 1BP 1with 1standing
Ans: 1C
Feedback: 1Isolated 1systolic 1hypertension 1is 1common 1in 1the 1elderly 1because 1of 1stiffening 1of 1the
1large 1arteries. 1This 1is 1often 1accompanied 1by 1widening 1of 1the 1pulse 1pressure. 1Orthostatic 1BP
1changes 1are 1often 1seen 1with 1postural 1changes 1and 1can 1account 1for 1falls 1as 1well.
16. Which 1of 1the 1following 1represents 1age-related 1changes 1in 1the 1lungs?
A) Decrease 1in 1chest 1wall 1compliance
B) Speed 1of 1expiration 1increases
C) Increase 1in 1respiratory 1muscle 1strength
D) Increased 1elastic 1recoil 1of 1lung 1tissue
Ans: 1A
Feedback: 1The 1lungs 1age 1along 1with 1the 1rest 1of 1the 1body. 1These 1changes 1include 1decreased
1lung 1and 1chest 1wall 1compliance, 1increased 1expiratory 1time, 1decreased 1muscle 1strength 1and
1cough, 1and 1decreased 1elastic 1recoil.
17. Mrs. 1Stanton 1is 1a 179-year-old 1widow 1who 1presents 1to 1your 1office 1for 1a 1routine 1BP 1visit.
1You 1note 1a 1new 1pulsatile 1mass 1in 1the 1right 1neck 1at 1the 1carotid 1artery. 1Which 1of 1the 1following
1is 1the 1most 1likely 1cause 1for 1this?
A) Anxiety
B) Carotid 1artery 1aneurysm
C) Kinking 1of 1the 1artery
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Ans: C
Feedback: These are not signs of normal aging and seem to be of acute onset. This makes
Alzheimer's less likely. Stroke and meningitis could cause these symptoms as well, but the
combination of the heat and a recent infection make delirium much more likely. Though she was
prescribed an antibiotic, she may not have improved because of bacterial resistance or because of
left 1jugular 1vein 1by 1impairing 1drainage 1within 1the 1thorax.
18. Mr. 1Chin 1is 1an 182-year-old 1man 1who 1comes 1to 1your 1office 1for 1a 1routine 1check. 1On
1examination, 1you 1notice 1a 1somewhat 1high-pitched 1murmur 1in 1the 1second 1right 1intercostal
1space 1during 1systole. 1It 1does 1not 1radiate 1and 1the 1rest 1of 1his 1examination 1is 1normal 1for 1his 1age.
1Which 1is 1true 1of 1the 1most 1likely 1cause 1of 1this 1murmur?
A) It 1often 1decreases 1carotid 1upstroke.
B) It 1carries 1with 1it 1increased 1risk 1for 1cardiovascular 1disease.
C) It 1is 1usually 1accompanied 1by 1an 1S3 1 gallop.
D) It 1is 1found 1in 110% 1of 1otherwise 1normal 1elderly 1patients.
Ans: 1B
Feedback: 1This 1murmur 1most 1likely 1represents 1aortic 1sclerosis, 1a 1common 1murmur 1affecting
1about 1one 1third 1of 1those 1near 160 1years 1of 1age. 1It 1is 1caused 1by 1calcification 1of 1the 1valve 1and 1is
1associated 1with 1cardiovascular 1risk. 1Aortic 1sclerosis 1does 1not 1usually 1cause 1obstruction 1to
1normal 1flow, 1so 1carotid 1upstroke 1should 1be 1normal, 1and 1it 1is 1not 1associated 1with 1an 1S3 1 gallop.
19. Mrs. 1Buckley 1is 1a 175-year-old 1widow 1who 1wants 1you 1to 1look 1at 1her 1teeth 1because 1over
1the 1past 12 1weeks 1she 1has 1had 1right-sided 1jaw 1pain 1when 1eating. 1It 1does 1not 1occur 1otherwise.
1She 1also 1has 1had 1a 1headache. 1 Which 1of 1the 1following 1should 1be 1considered?
A) Palpation 1of 1her 1temples
B) Dental 1referral
C) Ultrasound 1of 1the 1gallbladder
D) Inquiry 1about 1anosmia
Ans: 1A
Feedback: 1This 1story 1can 1be 1consistent 1with 1temporal 1arteritis, 1which 1can 1cause 1blindness 1in
115% 1of 1those 1affected. 1Early 1recognition 1is 1crucial. 1Most 1of 1these 1patients 1will 1have
1tenderness 1over 1one 1or 1both 1of 1the 1temporal 1arteries, 1and 1some 1have 1diminished 1temporal
1pulses 1as 1well. 1Early 1treatment 1with 1corticosteroids 1is 1indicated. 1It 1can 1also 1be 1associated
1with 1polymyalgia 1rheumatic, 1a 1condition 1which 1causes 1pain 1in 1the 1shoulder 1girdles 1and
1pelvis.
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20. Which of the following is commonly seen in aging men?
A) Erectile dysfunction in 20% of all men
B) Testicles ride higher within the scrotum
C) Strong response to visual erotic cues
D) 1Persistent 1sexual 1interest
Ans: 1D
Feedback: 1Erectile 1dysfunction 1affects 1about 1half 1of 1elderly 1men 1but 1sexual 1interest 1generally
1remains 1intact. 1A 1decrease 1in 1sexual 1interest 1may 1indicate 1other 1problems 1such 1as 1depression.
1Visual 1cues 1become 1less 1important 1and 1tactile 1stimulation 1more 1important. 1The 1testicles 1are
1positioned 1lower 1in 1the 1scrotum.
21. Which 1of 1the 1following 1accompanies 1decreased 1ovarian 1function?
A) Increased 1sleep
B) Diminution 1of 1sexual 1interest
C) Enlargement 1of 1the 1clitoris
D) Decrease 1in 1vaginal 1secretions
Ans: 1D
Feedback: 1Menopause, 1or 1the 1cessation 1of 1menses 1for 11 1year, 1commonly 1occurs 1in 1the 1late 140s
1to 1early 150s. 1Many 1experience 1hot 1flashes, 1sweating, 1chills, 1anxiety, 1decreased 1sleep, 1and 1urge
1incontinence. 1Dyspareunia 1is 1common 1secondary 1to 1decreased 1vaginal 1secretions. 1Sexual
1interest 1does 1not 1normally 1decrease. 1The 1clitoris 1and 1length 1of 1the 1vaginal 1vault 1decrease 1in
1response 1to 1decreased 1estrogen.
22. You 1are 1examining 1an 1elderly 1man 1and 1notice 1the 1following: 1decreased 1vibration 1sense 1in
1the 1feet 1and 1ankles, 1diminished 1gag 1reflex, 1right 1patellar 1reflex 1less 1than 1the 1left, 1and
1diminished 1abdominal 1reflexes. 1 Which 1of 1these 1is 1abnormal?
A) Decreased 1vibration 1sense
B) Diminished 1gag 1reflex
C) Diminished 1right 1patellar 1reflex 1compared 1to 1the 1left
D) Diminished 1abdominal 1reflexes
Ans: 1C
Feedback: 1Asymmetry 1on 1any 1examination 1is 1usually 1reason 1for 1concern. 1The 1other 1changes
1are 1commonly 1associated 1with 1aging. 1You 1may 1consider 1looking 1for 1other 1neurologic 1signs
1on 1the 1right, 1although 1occasionally 1you 1may 1mistake 1an 1abnormally 1brisk 1reflex 1to 1be 1normal
1when
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compared to the other side. It is usually a good idea to question whether the opposite side is
actually the abnormal one when you find asymmetry on examination.
23. Mrs. 1Glynn 1is 190 1years 1old 1and 1lives 1alone. 1 She 1is 1able 1to 1bathe, 1dress, 1prepare 1her 1food,
1and 1transfer 1from 1bed 1to 1chair 1independently. 1She 1has 1children 1in 1the 1area 1who 1help 1her 1with
1her 1medications 1and 1transportation 1needs. 1Which 1of 1the 1following 1is 1considered 1an
1instrumental 1activity 1of 1daily 1living?
A) Bathing
B) Dressing
C) Preparing 1food
D) Transferring 1from 1bed 1to 1chair
Ans: 1C
Feedback: 1Instrumental 1activities 1of 1daily 1living 1involve 1higher 1thought 1processes 1such 1as
1preparing 1food, 1whereas 1bathing, 1dressing, 1and 1transferring 1are 1considered 1physical 1activities
1of 1daily 1living.
24. Mr. 1Kelly 1comes 1to 1you 1today 1for 1a 1burning 1pain 1in 1his 1lower 1abdomen. 1This 1has 1gone
1on 1for 12 1months. 1He 1has 1received 1radiation 1for 1prostatic 1cancer 1for 1the 1past 1quarter. 1What
1assumptions 1could 1you 1draw 1from 1this?
A) This 1represents 1persistent 1pain.
B) His 1pain 1reporting 1is 1likely 1to 1be 1unreliable.
C) There 1are 1―red 1flags‖ 1present.
D) He 1is 1depressed.
Ans: 1C
Feedback: 1This 1scenario 1is 1consistent 1with 1acute 1pain, 1although 1this 1may 1become 1persistent 1if
1it 1lasts 1beyond 13 1months. 1The 1burning 1quality 1to 1the 1pain 1should 1be 1a 1red 1flag, 1along 1with
1descriptions 1of 1pain 1as 1―discomfort‖ 1or 1―soreness.‖ 1Depressed 1affect 1or 1changes 1in 1posture
1or 1gait 1are 1also 1red 1flags. 1 Studies 1have 1found 1that 1pain 1reporting 1in 1the 1elderly 1is 1accurate.
Although 1depression 1may 1be 1present, 1we 1have 1no 1indications 1of 1it 1in 1this 1scenario.
25. Mr. 1White's 1son 1brings 1him 1in 1today 1because 1he 1notes 1that 1Mr. 1White 1has 1not 1been
1himself 1lately. 1He 1seems 1forgetful 1and 1has 1not 1taken 1care 1of 1himself 1as 1he 1normally 1does.
1He 1has 1reported 1falling 1twice 1at 1home 1to 1his 1son 1and 1has 1telephoned 1late 1at 1night 1because 1of
1insomnia. 1His 1blood 1pressure 1and 1diabetes 1have 1been 1difficult 1to 1control 1and 1his 1warfarin
1dosing 1has
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become more difficult. Which of the following should you suspect?
A) Alzheimer's dementia
B) Alcohol use
C) Urinary tract infection
D) Stroke
Ans: 1B
Feedback: 1All 1of 1these 1answers 1are 1common 1diseases 1of 1the 1elderly 1and 1many 1have 1atypical
1presentations 1in 1this 1age 1group. 1The 1fact 1that 1his 1hypertension 1has 1become 1more 1difficult 1to
1control 1and 1his 1warfarin 1dosing 1is 1challenging 1to 1manage 1should 1lead 1you 1to 1consider 1that 1there
1is 1alcohol 1use. 1Further 1questioning, 1quantifying 1his 1use 1of 1alcohol, 1and 1application 1of 1the
1CAGE 1questionnaire 1may 1be 1useful.
26. Claire's 1daughter 1brings 1her 1in 1today 1after 1Claire 1fell 1at 1her 1home. 1 Which 1assessments
1are 1indicated 1at 1this 1time?
A) Orthostatic 1vital 1signs
B) Review 1of 1her 1medications
C) Assessment 1of 1gait 1and 1balance
D) All 1of 1the 1above
Ans: 1D
Feedback: 1Falls 1are 1common 1in 1the 1elderly 1and 1can 1often 1result 1in 1serious 1injuries. 1When
1assessing 1the 1cause 1of 1falls, 1gait 1and 1balance 1should 1be 1checked 1first. 1 Medication,
1particularly 1use 1of 1more 1than 1three, 1is 1associated 1with 1falls. 1Vision 1problems, 1lower-limb 1joint
1problems, 1and 1cardiovascular 1problems 1such 1as 1arrhythmias 1may 1be 1reasonable 1to 1search 1for.
1Orthostatic 1vital 1sign 1changes 1should 1be 1sought.
27. Mrs. 1Geller 1is 1somewhat 1quiet 1today. 1 She 1has 1several 1bruises 1of 1different 1colors 1on 1the
1ulnar 1aspects 1of 1her 1forearms 1and 1on 1her 1abdomen. 1She 1otherwise 1has 1no 1complaints 1and 1her
1diabetes 1and 1hypertension 1are 1well 1managed. 1Her 1son 1from 1out 1of 1state 1accompanies 1her 1today
1and 1has 1recently 1moved 1in 1to 1help 1her. 1 What 1should 1you 1suspect?
A) Overuse 1of 1aspirin
B) Frequent 1falls
C) Elder 1abuse
D) Depression
Ans: 1C
Feedback: 1 The 1different 1colors 1of 1the 1bruising 1indicate 1that 1they 1have 1occurred 1at 1different
1times 1and 1are 1unlikely 1to 1have 1resulted 1from 1a 1single 1fall. 1 The 1location 1of 1the 1bruising 1on 1the
1ulnar
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
aspects of the forearms potentially indicates that she was trying to defend herself and are not
typical areas to be bruised by a fall. Depression may be evident, but this is more likely to be a
result rather than a cause of her situation today. While nothing is proven, it would be wise to
interview her without her son in the room. If in doubt, a social worker consult may be helpful to
determine if elder abuse is occurring.
28. A 1patient 1comes 1to 1you 1for 1the 1appearance 1of 1red 1patches 1on 1his 1forearms 1that 1have
1been 1present 1for 1several 1months. 1They 1remain 1for 1several 1weeks. 1He 1denies 1a 1history 1of
1trauma. 1Which 1of 1the 1following 1is 1likely?
A) Actinic 1keratoses
B) Pseudoscars
C) Actinic 1purpura
D) Cherry 1angiomas
Ans: 1C
Feedback: 1Actinic 1purpura 1is 1a 1common 1benign 1skin 1condition 1of 1the 1elderly, 1frequently
1involving 1the 1forearms. 1 Pseudoscars 1are 1white 1patches 1and 1cherry 1angiomas 1are 1bright-red
1raised 1lesions 1usually 1found 1on 1the 1torso. 1Actinic 1keratoses 1are 1lesions 1resembling 1nevi, 1often
1with 1features 1which 1would 1be 1concerning 1if 1considering 1melanoma 1(review 1the 1ABCDEs 1of
1melanoma), 1but 1they 1produce 1a 1slightly 1greasy 1scale 1when 1scratched 1with 1a 1nail.
29. On 1routine 1screening 1you 1notice 1that 1the 1cup-to-disc 1ratio 1of 1the 1patient's 1right 1eye 1is
11:2. 1What 1ocular 1condition 1should 1you 1suspect?
A) Macular 1degeneration
B) Diabetic 1retinopathy
C) Hypertensive 1retinopathy
D) Glaucoma
Ans: 1D
Feedback: 1This 1cup-to-disc 1ratio 1means 1that 1the 1cup 1takes 1up 150% 1of 1the 1disc, 1which 1is
1abnormally 1large. 1 This 1is 1usually 1an 1indication 1of 1glaucoma, 1which 1is 1a 1common 1cause 1of
1visual 1loss 1in 1the 1elderly. 1The 1cup-to-disc 1changes 1are 1not 1seen 1in 1diabetes, 1hypertension, 1or
1macular 1degeneration. 1Many 1elderly 1do 1not 1have 1regular 1eye 1examinations 1and 1are 1not
1screened 1for 1glaucoma.
30. Which 1of 1the 1following 1is 1true 1of 1assessment 1of 1the 1vascular 1system 1in 1the 1elderly?
A) Fewer 1than 1one 1third 1of 1patients 1with 1peripheral 1vascular 1disease 1have 1symptoms 1of
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Bates' Nursing Guide to Physical Examination and History Taking / Edition 3 Testbank
claudication.
B) An aortic width of 2.5 cm is abnormal.
C) Bruits are commonly benign findings.
D) Orthostatic blood pressure and pulse are not useful in this population.
Ans: 1A
Feedback: 1It 1is 1the 1minority 1of 1patients 1with 1peripheral 1vascular 1disease 1who 1experience
1claudication; 1therefore, 1ankle–brachial 1ratios 1should 1be 1performed 1more 1frequently. 1The 1aorta
1should 1be 13 1cm 1or 1less. 1 Bruits 1usually 1indicate 1pathology, 1and 1even 1when 1there 1is 1not 1a
1significant 1blockage, 1the 1risk 1of 1vascular 1disease 1throughout 1the 1body 1is 1increased. 1Orthostatic
1vital 1signs 1are 1very 1useful 1in 1this 1population. 1 Remember 1to 1observe 1the 1pulse 1as 1well, 1as
1failure 1of 1the 1heart 1to 1increase 1its 1rate 1is 1a 1common 1cause 1of 1orthostatic 1hypotension. 1 This 1can
1occur 1as 1a 1result 1of 1autonomic 1neuropathy 1or 1medications 1such 1as 1beta-blockers, 1among 1other
1causes.
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