(Test Bank) Seidel’s Guide to Physical Examination

Ball, 9

Nursing

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9th Edition

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Test Bank for Seidel’s Guide to Physical Examination, The downloadable file consists of 199 pages, and the total size of the file is 1.3 MB. Purchase now only for highly discounted price.

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Chapter 01: The History and Interviewing Process Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which question would be considered a “leading question?” a. “What do you think is causing your headaches?” b. “You don’t get headaches often, do you?” c. “On a scale of 1 to 10, how would you rate the severity of your headaches?” d. “At what time of the day are your headaches the most severe?” ANS: B Stating to the patient that he or she does not get headaches would limit the information in the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an open -ended question. Asking the patient how he or she would rate the severity of the headaches and asking what time of the day the headaches are the most severe are d irect questions. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When are open -ended questions generally most useful? a. During sensitive area part of the interview b. After several closed -ended questions have been asked c. While designing the genogram d. During the review of systNemsR I G B.C M ANS: A U S N T O Asking open -ended questions during the sensitive part of the interview allows you to gather more information and establishes you as an empathic listener, which is the first step of effective communication. Asking closed -ended questions may stifle the patie nt’s desire to discuss the history of the illness. Interviewing for the purpose of designing a genogram or conducting a review of systems requires more focused data than can be more easily gathered with direct questioning. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Periods of silence during the interview can serve important purposes, such as: a. allowing the clinician to catch up on documentation. b. promotin g calm. c. providing time for reflection. d. increasing the length of the visit. ANS: C Silence is a useful tool during interviews for the purposes of reflection, summoning courage, and displaying compassion. This is not a time to document in the chart, but rather to focus on the patient. Periods of silence may cause anxiety rather than promo te calm. The length of the visit is less important than getting critical information. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? a. “After 3 days, you’re tired of coughing. Have you had a fever?” b. “I’d like to hear more about your experiences. Where were you born?” c. “I don’t know what’s wrong. You could have almost any disease.” d. “I’ll examine you and figure out later what the problem is.” ANS: A “After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at focusing on the chief compliant to gather more data and does not digress from the issue. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. After you ask a patient about her family history, she says, “Tell me about your family now.” Which response is generally most appropriate? a. Ignore the patient’s comment and continue with the interview. b. Give a brief, undetailed answer. c. Ask the patient why she needs to know. d. Tell the patient that you do not discuss your family with patients. ANS: B NURSINGTB.COM Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without invading your private life. Ignoring the patient’s comment, continuing with the interview, and telling the patient that you do not discuss your family with patients will potentially anger or frustrate her and keep her from sharing openly. Asking the patien t why she needs to know will distract from the real reason she is seeking care and instead move the interview conversation away from the topics that should be discussed. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to: a. continue to collect information regarding the chief complaint in an unhurried manner. b. finish the interview as rapidly as possible. c. ask the patient to take a deep breath and calm down. d. ask the patient if she wants to wait until another day to talk to you. ANS: A With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. If you as a healthcare provider are hurried, the patient will be more anxious. The best way to assist an anxious patient is to not hurry and remain calm, because this will communicate caring to the patient. Asking the patient if she wants to wait until another day to talk to you delays the needed health care. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. Ms. A states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one of the following statements is the most appropriate caregiver response? a. “Try to think about the good things in life.” b. “What in life is causing you such pain?” c. “You can’t mean what you’re saying.” d. “If you think about it, nothing is worth getting this upset about.” ANS: B Specific but open -ended questions are best used when the patient has feelings of loss of self-worth and depression. “Try to think about the good things in life,” “You can’t mean what you’re saying,” and “If you think about it, nothing is worth getting this upset about” are statements that will hurry the patient and offer only superficial assurance. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process —asses sment MSC: Physiologic Integrity: Physiologic Adaptation 8. You are collecting a history from a 16 -year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: NURSINGTB.COM a. given the opportunity to be interviewed without the parent at some point during the interview. b. mailed a questionnaire in advance to avoid the need for them to talk. c. ignored while you address all questions to the parent. d. allowed to direct the flow of the interview. ANS: A The adolescent should be given the opportunity to give information directly. This enhances the probability that the adolescent will follow your advice. Mailing a questionnaire in advance to avoid the need for her to talk does not assist the adolescent in learning to respond to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored while you address all questions to the parent, the patient will feel as though sh e is just being discussed and is not part of the process for the health care. The healthcare provider should always direct the flow of the interview according to the patient’s responses. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Information that is needed during the initial interview of a pregnant woman includes all the following except : a. the gender that the woman hopes the baby will be. b. past medical history. c. healthcare practices. U S N T O d. the woman’s remembering (knowledge) about pregnancy. ANS: A The initial interview for the pregnant woman should include information about her past medical history, assessment of health practices, identification of potential risk factors, and assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is not as important as the information about her past medical history, healthcare practices, and the woman’s remembering (knowledge) about her pregnancy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. When interviewing older adults, the examiner should: a. speak extremely loudly, because most older adults have significant hearing impairment. b. provide a written questionnaire in place of an interview. c. position himself or herself facing the patient. d. dim the lights to decrease anxiety. ANS: C The healthcare provider should position himself or herself so that the older patient can see his or her face. Shouting distorts speech, dimming the lights impairs vision, and a written interview may be necessary if all else fails. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. To what extent should the paNtienRt wiIth aGphyBs.icaCl diMsability or emotional d isorder be involv ed in providing health history information to the health professional? a. The patient should be present during information collection but should not be addressed directly. b. All information should be collected from past records and family members while the patient is in another room. c. The patient should be involved only when you sense that he or she may feel ignored. d. The patient should be fully involved to the limit of his or her ability. ANS: D Patients who are disabled may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Patients should be addressed directly and participate in the interview to the extent of their ability. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. When taking a history, the nurse should: a. ask the patient to give you any information he or she can recall about his or her health. b. start the interview with the patient’s family history. c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. ANS: C To give structure to the present problem or chief complaint, the provider should proceed in a chronologic and sequential framework. Asking patients to give any information they can recall about their health and using a holistic and electric structure do not provide structure to the history. Gathering the patient’s family history is only the first step. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. When questioning the patient regarding his or her sexual history, which question should be asked initially ? a. “Do you have any particular sexual likes or dislikes?” b. “Do you have any worries or concerns regarding your sex life?” c. “How often do you have intercourse and with whom?” d. “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” ANS: B When approaching questioning about a sensitive area, it is recommended that the provider first ask open -ended questions that explore the patient’s feelings about the issue. “Do you have any particular sexual likes or dislikes?” is not a question that should be asked in an interview regarding sexual history. “How often do you have intercourse and with whom?” and “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” are not questions that should be asked initially in an interview regarding the patient’s sexual history. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessNmUenRt SINGMTSBC.: CPhOysMiologic Integrity: Physiologic Adaptation 14. A guideline for history taking is for caregivers to: a. ask direct questions before open -ended questions so that data move from simple to complex. b. ask for a complete history at once so that data are not forgotten between meetings. c. make notes sparingly so that the patient can be observed during the history taking. d. write detailed information as stated by patients so that their priorities are reflected. ANS: C During the interview, you should maintain eye contact with the patient, observing body language and proceeding from open -ended to direct questions. Asking direct questions first may upset the patient. During the interview you should gather as much informat ion as you need for the current reason the patient is seeking health care. It is important to focus on the patient. Brief notes can be charted, but you should maintain eye contact with the patient, observing body language and proceeding from open -ended to direct questions. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Mr. D complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the: a. chief complaint. b. past medical history. c. personal and social history. d. review of systems. ANS: C Habits are included within the personal and social history. The chief complaint is th e reason the patient is seeking health care. The past medical history is made up of the previous medical conditions that the patient has had. The review of systems is an overview of problems with other body systems. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Direct questioning about domestic violence in the home should be: a. a routine component of history taking with female patients. b. avoided for fear of offending the woman’s partner. c. conducted only in cases in which there is a history of abuse. d. used only when the patient is obviously being victimized. ANS: A The presence of domestic violence should be routinely queried, and the questioning should be direct for all female patients. Direct questioning about domestic violence in the home should not be avoided for fear of offending the woman’s partner, should be part of a routine examination, and should not be used only when the patient is obviously being victimized. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. A tool us ed to screen adolescNentsRforIalcGohoBlis.mCis Mthe: a. CAGE. b. CRAFFT. c. PACES. d. HITS. ANS: B U S N T O The CRAFFT tool is used to screen for alcoholism in adolescents. The CAGE test is used to screen for alcoholism in adults. PACES is used to screen adolescents for important issues in their life. HITS is the screen for domestic violence. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health? a. Attachment to parents b. High self-esteem c. Low peer support needs d. Propensity for risk taking ANS: D Adolescents tend to experiment with risky behaviors that can lead to a high incidence of morbidity and mortality. U S N T O sta ding (Com rehension) DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADL) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. ANS: B A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, ADL, and instrumental activities of daily living (IADL). DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. Constitutional symptoms in the ROS refer to: a. height, weight, and body mass index. b. fever, chills, fatigue, and malaise. c. hearing loss, tinnitus, and diplopia. d. rashes, skin turgor, and temperature. ANS: B General constitutional symptoms refer to pain, fever, chills, malaise, fatigue, night sweats, sleep patterns, and weight (average, preferred, present, change). N R I G B.C MDIF: Cognitive Level: Under n p OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history. a. complete b. inventory c. problem or focused d. interim ANS: C If the patient is well known, or if you have been seeing the patient for the same problem over time, a focused history is appropriate. A complete history is only obtained during initial visits or during a complete history and physical examination (H&P). An inventory is related to but does not replace the complete history. It touches on the major points without going into detail. This is useful when the entire history taking will be completed in more than one session. An interim history is only obtained during a return of the patient after several months of absence. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which are appropriate for the interview setting with a patient? (Select all that apply.) a. Playing music in the background b. Ensuring comfort for all involved c. Maintaining eye contact d. Using a conversational tone e. Keeping the door open f. Removing physical barriers ANS: B, C, D, F The interview setting requires comfort for all involved, removal of physical barriers, unobtru sive access to a clock, maintaining eye contact, and using a conversational tone. Playing music in the background may be distracting and keeping the door open does not provide for privacy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation NURSINGTB.COM Chapter 02: Cultural Competency Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which statement is true regarding the relationship of physical characteristics and culture? a. Physical characteristics should be used to identify members of cultural groups. b. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. c. To be a member of a specific culture, an individual must have certain identifiable physical characteristics. d. Gender and race are the two essential physical characteristics used to identify cultural groups. ANS: B Physical characteristics are not used to identify cultural groups; there is a difference between the two, and they are considered separately. Physical characteristics should not be used to identify members of cultural groups. To be a member of a specific culture, an individual does not need to have certain identifiable physical characteristics. You should not confuse physical characteristics with cultural characteristics. Gender and race are physical characteristics, not cultural characteristics, and are not used to identify cultural groups. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. An image of any group that rNejecRts itIs poGtenBtia.l Cfor Moriginality or individuality is known as a(n): a. acculturation. b. norm. c. stereotype. d. ethnos. ANS: C U S N T O A fixed image of any group that rejects its potential for originality or individuality is the definition of stereotype. Acculturation is the process of adopting another culture’s behaviors. A norm is a standard of allowable behavior within a group. Ethnos implies the same race or nationality. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L’s son tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? a. “With your father’s permission, we will examine the stone and request that it be returned to him.” b. “The stone must be sent to the lab for examination and therefore cannot be kept.” c. “We cannot let him keep his stone because it violates our infection control policy.” d. “We don’t know yet if your father has another kidney stone, so we must analyze this one.” ANS: A We should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient’s cultural background. “With your father’s permission, we will examine the stone and request that it be returned to him” is the most appropriate response. “The stone must be sent to the lab for examination and therefore cannot b e kept” and “We don’t know yet if your father has another kidney stone, so we must analyze this one” do not support the patient’s request. “We cannot let him keep his stone because it violates our infection control policy” does not provide a reason that it would violate an infection control policy. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The motivation of the healthcare professional to “want to” engage in the process of becoming culturally competent, not “have to,” is called: a. cultural knowledge. b. cultural awareness c. cultural desire d. cultural skill. ANS: C Cultural encounters are the continuous process of interacting with patients from culturally diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a cultural group and to develop cultural desire, cultural awareness, cultural skill, and cultural knowledge. Cultural awareness is deliberate self -examination and in -depth exploration of one’s biases, stereotypes, prejudices, assumptions, and “-isms” that one holds about individuals and groups who aNreUdRifSfeIreNnGt fTroBm.tCheOmM. Cultur al knowledge is the process of seeking and obtaining a sound educational base about culturally and ethnically diverse groups. Cultural skill is the ability to collect culturally relevant data regarding the patient’s presenting problem, as well as accurately performing a culturally based physical assessment in a culturally sensitive manner. Cultural desire is the motivation of the healthcare professional to want to engage in the process of becoming culturally competent, not have to. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mr. Marks is a 66 -year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? a. “How often do you have medical examinations?” b. “What is your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” ANS: D “Why do you think you are having these symptoms?” is an open -ended question that avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. The other questions do not explore the patient’s cultural beliefs about health problems. U S N T O DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. The definition of ill or sick is based on a: a. stereotype. b. cultural behavior. c. belief system. d. cultural attitude. ANS: C The definition of ill or sick is based on the individual’s belief system and is determined in large part by his or her enculturation. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. A 22 -year-old female nurse is interviewing an 86 -year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask? a. “We will be able to communicate better if you look at me.” b. “It’s hard for me to gather useful information because your answers are so short.” c. “Are you uncomfortable talking with me?” d. “Does your religion make it hard for you to answer my questions?” ANS: C It is all right to ask if the patient is uncomfortable with any aspect of your person and to talk about it; the other choices are less respectful. N R I G B.C M DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to: a. tell him that you understand his need to be alone. b. ask whether he has any questions. c. ask whether he would prefer to speak to the clinician. d. tell him that it is all right to be angry. ANS: B The English worry about being overheard and tend to speak in modulated voices so, when they lean in toward you, they are probably poised to ask a question. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Middle Eastern groups is Western medicine’s attempts to: a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. U S N T O d. restore balance in an individual’s life. ANS: B A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more holistic approach. Using a holistic approach, establishing harmony between a person and the entire cosmos, and restoring balance in an individual’s life would not be troublesome to many Hispanics, Native Americans, Asians, and Arabs. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The attitudes of the healthcare professional: a. are largely irrelevant to the success of relationships with the patient. b. do not influence patient behavior. c. are difficult for the patient to sense. d. are culturally derived. ANS: D The attitudes of the healthcare provider are foundationally derived from his or her own culture; understanding this is relevant to the success of patient relationships. Attitudes of the healthcare professional are easily detected by others, and they influence patient behavior; they are not irrelevant to the success of relationships with the patient; they do influence patient behavior; and they are not difficult for the patient to sense. 11. 1 1 . DIF: Cognitive Level: Understanding (Comprehen sion) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation N R I G B.C M Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator? a. Race b. Rite c. Ritual d. Norm ANS: A Race is a physical, not a cultural, differentiator. Rite is a prescribed, formal, customary observance. Ritual is a stereotypic behavior regulating religious, social, and professional behaviors. A norm is a prescribed standard of allowable behavior within a group. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to: a. forego the examination for fear of violating cultural norms. b. ask a colleague from the same geographic area if this examination is acceptable. c. inform the patient of the reason for the examination and ask if it is acceptable to him. d. refer the patient to a provider more knowledgeable about cultural differences. ANS: C Asking, if you are not sure, is far better than making a damaging mistake. Not completing the examination could cause the patient further harm. Asking a colleague from the same geographic area if this examination is acceptable may not be appropriate. Refer ring the patient to a provider more knowledgeable about cultural differences at this point is unnecessary. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Mr. Jones is a 45-year-old patient who presents to the office. A person’s definition of illness is likely to be most influenced by: a. race. b. socioeconomic class. c. enculturation. d. age group. ANS: C The definition of illness is determined in large part by the individual’s enculturation (the process whereby an individual assumes the traits and behaviors of a given culture). DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. As the healthcare provider, you are informing a patient that he or she has a terminal illness. This discussion is most likely to be discouraged in which cultural group? a. Navajo Native Americans b. Dominant Americans NURSINGTB.COM c. First-generation African descendants d. First-generation European descendants ANS: A The Navajo culture believes that thought and language have the power to shape reality; the desire to avoid discussing negative information is particularly strong in this culture. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group? a. Native Americans b. Hispanics c. Chinese d. Italians ANS: C The Chinese are most likely to use MSG and soy sauce in their diet. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. An example of a cold condition is: a. a fever. b. a rash. c. tuberculosis. d. an ulcer. ANS: C A cold condition in cultures with a holistic approach is tuberculosis. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which variables can intrude on successful communication? (Select all that apply.) a. Social class b. Gender c. Stereotype d. Phenotype e. Age ANS: A, B, E Social class, age, and gender are variables that characterize everyone; they can intrude on successful communication if there is no effort for mutual knowledge and understanding. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Campinh a-Bacote’s Process NofUCRuSltuIraNl GCTomBp.eCteOncMe Mode l includes which cultur al constructs? (Select all that apply.) a. Desire b. Awareness c. Thought processes d. Skill e. Language ANS: A, B, D Campinha -Bacote’s Process of Cultural Competence Model includes the cultural constructs encounters, desires, awareness, knowledge, and skill. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation Chapter 03: Examination Techniques and Equipment Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. According to the guidelines for Standard Precautions, the caregiver’s hands should be washed: a. only after touching body fluids with ungloved hands and between patient contacts. b. only after touching blood products with ungloved hands and after caring for infectious patients. c. only after working with patients who are thought to be infectious. d. after touching any body fluids or contaminated items, regardless of whether gloves are worn. ANS: D Handwashing is to be done after removal of gloves, between patient contacts, and after touching body fluids, regardless of whether gloves are used. The nurse should never touch body fluids or blood products with ungloved hands. The nurse should use hand hygiene regardless of a patient’s possible infection. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adap tation 2. Which patient is at the highest risk for developing latex allergy? a. The new patient who has no chronic illness and has never been hospitalized b. The patient who has had multiple procedures or surgeries c. The patient who is a vegeNtariRan I G B.C M d. The patient who is allergicUto cSontrNast Tdye O ANS: B The patient who has had multiple procedures or surgeries has a higher rate of exposure to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. DIF: Cognitive Level: Understan ding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Which technique is used during both the history taking and the physical examination process? a. Auscultation b. Inspection c. Palpation d. Percussion ANS: B Inspection is the technique that is used while gathering and validating data during both the history taking and the actual hands -on physical examination. Auscultation, palpation, and percussion are not used during the history taking and physical examinatio n processes. It is not possible to listen to the patient talking and use the stethoscope at the same time. The focus is on the patient’s response to your touch and what you are feeling; it is not possible to perform palpation and listen to the patient talking at the same time. U S N T O DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The use of secondary, tangential lighting is most helpful in the detecti on of: a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. ANS: D Tangential lighting is used to cast shadows to observe contours and variations in body surfaces best. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse, that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? a. Drape the patient and observe the rectal area. b. Tell the patient that his doctor will be notified of his problem. c. Tell the patient that you will ask the male nurse on the next shift to check on the problem. d. Give the patient an ice pack to apply to the area. ANS: A Necessary exposure for direct observation, while adjusting for modesty, is warranted. The compl aint warrants valid ationNbeRforeIrefGerraBl o.rCdelMegation. Before you call the clinici an, you need to assess the patient. The assessment should not wait for another shift. Before treatment, it is important to assess the complaint. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration? a. Dorsal surface b. Finger pads c. Fingertips d. Ulnar surface ANS: D The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The finger pads and fingertips are best for palpating pulses. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. The dorsal surface of the hand is most often used for the assessment of: a. crepitus. b. temperature. c. texture. d. vibration. ANS: B The dorsal surface, or back of the hand, is best for assessing warmth, or temperature. The palmar surface, rather than the dorsal surface, is best for assessing crepitus. The palmar surface, rather than the dorsal surface, is best for assessing texture. The ulnar surfaces of the hand and fingers, rather than the dorsal surface, are best for assessing vibration. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process? a. Light palpation b. Deep palpation c. Percussion d. Auscultation ANS: D Auscultation precedes palpation or percussion of the abdomen because these techniques can stimulate peristalsis, which may alter correct assessment of the abdominal sounds. Light palpation, deep palpation, and percussion should not be completed until auscultation is completed. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessNmUenRt SINGMTSBC.: CPhOysMiologic Integrity: Physiologic Adaptation 9. The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder the percussion tone. b. The less dense the medium, the louder the percussion tone. c. The more hollow the area percussed, the quieter the percussion tone. d. Percussion over muscle areas produces the loudest percussion tones. ANS: B Percussion sounds vary according to the tissue being percussed. Less dense tissue (such as that over normal lungs) produces a loud tone, whereas more dense tissue (such as a muscle) produces a softer tone. The more dense the medium, the softer is the percu ssion tone. The more hollow the area, the louder is the percussion tone. Percussion tones over muscle are soft and flat. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. Expected normal percussion tones include: a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. ANS: C A normal lung produces resonance percussion tones, whereas an empty stomach is expected to produce tympany. Dullness indicates atelectasis of the lung. Hyperresonance over the lungs indicates emphysema. Flatness occurs over muscle. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. During percussion, a dull tone is expected to be heard over: a. healthy lung tissue. b. emphysemic lungs. c. the liver. d. most of the abdomen. ANS: C Dull tones are expected over denser areas such as the liver. Healthy lung tissue is resonant. Emphysemic lungs are hyperresonant. Tympany is heard over most of the abdomen. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. When using mediate or indirect percussion, which technique is appropriate? a. Place the palmar surface of the nondominant hand on the body surface, with the fingers held together. b. Place the palmar surface of the nondominant hand on the body surface, with the fingers slightly spread apart. c. Place the uln ar surface ofNtheRnonIdomGinaBn.t hCandMon the body surface, with the fingers together. U S N T O d. Place the ulnar surface of the nondominant hand on the body surface, with the fingers slightly spread apart. ANS: B The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. A helpful tip to improve elicitation of correct tones is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint firmly against the body surface. This lifting of the fingertip avoids dampening of the vibratory sounds. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. During percussion, the downward snap of the striking fingers should originate from the: a. shoulder. b. forearm. c. wrist. d. interphalangeal joint. ANS: C The downward snap of the striking fingers should originate from the wrist. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or kidneys? a. Finger percussion b. Palmar percussion c. Fist percussion d. Forearm percussion ANS: C Fist percussion is a direct percussion technique used to elicit tenderness over organs such as the liver, gallbladder, or kidneys. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. During auscultation, you can limit your perceptual field best by: a. asking patients to describe their symptoms. b. closing your eyes. c. performing auscultation before percussion. d. using an aneroid manometer. ANS: B By closing your eyes, your sense of hearing becomes more acute, and it increases your ability to isolate sounds. Asking patients to describe their symptoms does not assist in the technique of auscultation. The only time that auscultation occurs before percussion is in examination of the abdomen. Using an aneroid manometer does not assist in the tec hnique of auscultation. During aus cultation, the onlyNeUquRipSmIeNntGnTeeBd.edCiOs tMhe stethoscop e. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty distinguishing between respirations and heartbeats. Which technique can you use to facilitate your assessment? a. Anticipate the next sounds. b. Isolate each cycle segment. c. Listen to all sounds together. d. Move the stethoscope clockwise. ANS: B If you are hearing everything at once, it is more difficult to distinguish different sounds. Try isolating each segment and listen to that segment intently; then move on to anot her segment. For example, listen only to breath sounds, then only to inspiratory breath sounds, and then only to expiratory breath sounds. Anticipating the next sounds will not facilitate the assessment. Listening to all sounds together will not facilitate the assessment. One of the most difficult achievements in auscultation is learning to isolate sounds. Moving the stethoscope clockwise will not facilitate the assessment. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. Auscultation should be carried out last, except when examining the: a. neck area. b. heart. c. lungs. d. abdomen. ANS: D Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Tympanic thermometers measure body temperat ure when a probe is placed: a. anterior to the ear. b. posterior to the ear. c. under the ear. d. in the auditory canal. ANS: D Tympanic thermometer probes are placed at the external opening of the auditory canal. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. A scale used to assess patients’ weight should be calibrated: a. only by the manufacturer. b. by a qualified technician Nat reRgulIarlyGschBe.duCledMintervals. c. each time it is used. U S N T O d. when necessary, with the patient standing on the scale. ANS: C Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. The manufacturer does not calibrate the scale after it is sold. A qualified technicia n does not calibrate the scale at regularly scheduled intervals. Scales cannot be calibrated with the patient standing on the scale. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. The height -measuring attachment of the standing platform scale should be pulled up: a. before the patient steps on the scale. b. before the scale is balanced. c. after the patient steps on the scale. d. only after weight has been assessed. ANS: A To ensure patient safety, the arm of the height -measuring attachment should be pulled up before the patient steps on the scale, after the scale is balanced, and before weight is assessed. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. The infant should be placed in which position to have his or her height or length measured? a. Vertically, with the examiner’s hands under the infant’s axillae b. Supine on a measuring board c. Prone on a measuring board d. In the lateral position, with the toes against a measuring board ANS: B The infant should be placed supine on a measuring board to measure height or length. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise and then counterclockwise to compensate for: a. amblyopia. b. astigmatism. c. myopia. d. strabismus. ANS: C Rotating the lens selector compensates for myopia (nearsightedness) or hyperopia (farsightedness) in the examiner and patient. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. The pneumatic attachment foNr UthRe SotIosNcoGpTe Bis.uCseOd Mto ev aluate: a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. ANS: D The pneumatic attachment on the otoscope produces a puff of air directed to the tympanic membrane, resulting in its movement. The pneumatic attachment for the otoscope is not used to evaluate ear canal patency, eardrum landmarks, or hearing acuity. Ear canal patency is assessed by visually inspecting the ear. Hearing acuity is assessed by the whisper test. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —assessm ent MSC: Physiologic Integrity: Physiologic Adaptation 24. Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the: a. tuning fork. b. reflex hammer. c. otoscope with pneumatic attachment. d. tympanometer. ANS: D This patient is describing eustachian tube dysfunction. The tympanometer measures compliance of the middle ear as air pressures are varied. It is an objective means of assessing the function of the ossic ular chain, eustachian tube, and tympanic membrane. The tuning fork assesses vibration. The reflex hammer assesses tendon reflexes. The otoscope with pneumatic attachment assesses tympanic membrane movement. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: a. buzzing or tingling sensations. b. buzzing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level. ANS: C Normal speech has a range of 300 to 3000 Hz; therefore the 500- to 1000 -Hz fork is used most often because it can estimate hearing loss in the range of normal speech. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. To perform a deep tendon reflex measurement, you should: a. briskly tap the tendon with the rubber end of the hammer. b. place the hammer firmly on the tendon for 3 to 5 seconds. c. tap the silver end of the hammer on the tendon. d. use the needle implement to determine sensory perception. ANS: A NURSINGTB.COM Deep tendon reflexes are measured by quickly and firmly tapping either end of the rubber hammer on the stretched tendon and then observing muscle movement. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrit y: Physiologic Adaptation 27. A variant of the percussion hammer is the neurologic hammer, which is equipped with which of the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell ANS: A The neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews to reveal an attached sharp needle. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Transillumination functions on the principle that: a. air, fluid, and tissue transmit light differentially. b. black light causes certain substances to fluoresce. c. converging and diverging light brings structures into focus. d. tangential light casts shadows that illuminate contours. ANS: A Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Which of the following are the causes of hyperreflexia? (Select all that apply.) a. Cold stirrups b. Standard scale c. Insertion of a speculum d. Fever e. Pressure during bimanual examination ANS: A, C, E Hyperreflexia is often caused by a cold, hard, examination table, cold stirrups, insertion or manipulation of a speculum, or pressure during bimanual or rectal examinations. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process —assessment MSC: Physiologic Integrity: Physiologic Adaptation NURSINGTB.COM Chapter 04: Clinical Reasoning Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. After the subjective and objective data have been prioritized, the next step is to: a. order laboratory tests. b. formulate a problem list. c. initiate appropriate referrals. d. initiate therapy. ANS: B After the data have been prioritized and a presumed diagnosis is made, the next step is to consider the appropriate laboratory tests, imaging studies, or specialty consultations. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —evaluating MSC: Safe and Effective Care: Management of Care 2. New findings of unknown causes are: a. problems to be noted on the problem list. b. deferred for subsequent visits. c. diagnosed before physical examination. d. reserved for specialists. ANS: A New findings of unknown causes are added to the problem list, but do not let them become a red herring that distr acts youNr aUttRenStiIonNfGroTmBt.heCcOenMtral issues. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process —diagnosis MSC: Safe and Effective Care: Management of Care 3. Which is an accepted method of making a diagnosis? a. Relying on intuition b. Making maximal use of laboratory tests c. Using first assumptions d. Using algorithms ANS: D Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process —diagnosis MSC: Safe and Effective Care: Management of Care 4. The adage that “common problems occur commonly” advises the practitioner to: a. always diagnose the patient’s problem in terms of what their practice usually sees. b. refer any uncommon complaints to specialists as soon as possible. c. not consider more than one diagnosis unless necessary. d. examine uncommon problems critically before assuming that the issue is an unusual presentation of a common problem.