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NURS 6512 exam 3CA. 100% Done and Correct

• The opening of the cervix is referred to as the a. introitus. b. pouch of Douglas. c. cervical isthmus. d. cervical os. e. anterior fornix. The uterus opens into the vagina at the cervical os. REF: p. 419 • The vaginal mucosa of a woman of childbearing years should appear a. transversely rugated. b. moist and excoriated. c. dry and papular. d. smooth and pink. e. moist with vertical ridges. Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation. REF: p. 418 • The adnexa of the uterus are composed of the a. corpus and cervix. b. fallopian tubes and ovaries. c. uterosacral and broad ligaments. d. round ligaments and ovaries. e. vagina and fundus. The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus. REF: p. 419 • During ovulation, the cervical mucus becomes more a. scant. b. bloody. c. yellow. d. stringy. e. odorous. During ovulation the cervical mucus is increased and is stringy and elastic (spinnbarkeit) REF: p. 421 • The pelvic joint that separates most appreciably during late pregnancy is the a. sacroiliac. b. symphysis pubis c. sacrococcygeal. d. iliofemoral. e. sacrosciatic notch. Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur. REF: p. 423 • Pregnancy-related cervical changes include a. flattening and lengthening. b. thinning and reddening. c. hardening and pallor. d. shortening and reddening. e. softening and bluish coloring. During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign). REF: p. 423 • The conventional definition of menopause is a. 3 months with no menses. b. 1 year with no menses. c. 6 months of progressively shorter menses. d. 3 consecutive anovulatory cycles. e. the cessation of ovulation. Menopause is defined as 1 year without menses. REF: p. 423 • Which systemic feature is related to the effects of menopause? a. Increased intraabdominal fat deposition b. Decreased LDL levels c. Cold intolerant d. Decreased cholesterol levels e. Decreased risk of cardiovascular disease Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes. REF: p. 423 • Which factor is associated with an increased risk of cervical cancer? a. Endometriosis b. Low parity c. HPV vaccination d. High socioeconomic status e. Early parity Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who were not pregnant until they were 25 years or older. REF: p. 425 • The risk of ovarian cancer is increased by a history of a. low-fat diet. b. cigarette smoking. c. age between 35 and 50 years. d. thin body habitus. e. nulliparity. There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer. REF: p. 425 • The form of gynecologic cancer that is increased in women who have taken tamoxifen is a. vaginal. b. cervical. c. ovarian. d. endometrial. e. perineal skin. Tamoxifen is an antiestrogen drug that acts like an estrogen in the uterus. REF: p. 426 • The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter’s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child’s a. drug ingestion. b. fluid intake. c. risk for sexual abuse. d. hormone responsiveness. e. fat intake. Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse. REF: p. 440 • When you enter the examination room of a patient who is scheduled for a pelvic examination, you note that she seems very anxious. You should a. tell her that there is nothing to be afraid of. b. try to determine the source of anxiety. c. avoid eye contact. d. proceed as though nothing is wrong. e. reschedule for another time. Most women do not have marked anxiety about a pelvic examination. If your patient does, you will need to find out why she is anxious before proceeding with the examination. REF: p. 427 • The female patient should ideally be in which position for the pelvic examination? a. Fowler b. Prone c. Lateral-supine d. Lithotomy e. Trendelenburg Ideally, position the woman in a lithotomy position for a pelvic examination. REF: p. 426 • During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of a. a cystocele. b. a rectocele. c. vaginal prolapse. d. rectal prolapse. e. hymenal remnants. Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele. REF: p. 435 • When you plan to obtain cytologic studies, speculum introduction may be facilitated by a. Valsalva maneuver. b. lubrication with warm water. c. use of plastic speculum. d. opening the blades completely. e. lubrication with gel. It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water. REF: p. 431 • Which of the following findings indicates a possible gonococcal infection? a. Vaginal prolapse b. Discharge from urethra or Skene glands c. Irregular urethral orifice in midline d. Irregular vaginal edges at introitus e. Bulging of anterior or posterior vaginal wall When milking the Skene glands produces a discharge, it is most commonly a gonococcal infection. REF: p. 441 • When performing a gynecologic exam, the examiner should change gloves after touching the patient’s a. anal area. b. Bartholin glands. c. Skene glands. d. cervix. e. urethra. Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas. REF: p. 430 • During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus. a. retroverted b. anteverted c. midline d. laterally deviated e. retroflexed The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus. REF: p. 431 • The presence of cervical motion tenderness may indicate a. pregnancy. b. nulliparity. c. pelvic inflammatory disease. d. vulvovaginitis. e. malignancy. Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions. REF: p. 436 • Which one of the following is a proper technique for use of a speculum during a vaginal examination? a. Allow the labia to spread; insert the speculum slightly open. b. Press the introitus upward; insert the closed speculum horizontally. c. Press the introitus downward; insert the closed speculum obliquely. d. Spread the labia; insert the closed speculum horizontally. e. Insert one finger; insert the opened speculum. Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely. REF: p. 430 • During a routine vaginal examination, you insert the speculum and visualize the cervix. The cervix projection into the vaginal vault is approximately 5 cm. Upon bimanual examination, you would expect to find the uterus a. in the midline position. b. in the retroverted position. c. in the anteverted position. d. deviated to the left or right. e. in the retroflexed position. Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position. REF: p. 431 • Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should a. chart this as nabothian cysts. b. chart this as a friable cervix. c. obtain a viral culture. d. test the pH of the cervical os. e. chart this as an eroded cervix. This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted. REF: p. 431 • An examiner rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection? a. Gonococcal culture b. Cytology smear c. Haemophilus smear d. Trichomonas smear e. Fungal cultures This describes the technique for obtaining a cytology Pap smear. REF: p. 433 • When collecting specimens, which sample should be obtained first? a. Chlamydia swab b. Gonococcal culture c. Pap smear d. Wet mount e. Potassium hydroxide prep A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first. REF: p. 433 • Dacron swabs are necessary when testing for which condition? a. Candidiasis b. Pregnancy c. Trichomonas d. Bacterial vaginosis e. Chlamydia DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cotton-tipped applicator may interfere with the test results. REF: p. 435 • The visualization of a large proportion of “clue cells” on your wet mount slide examination suggests a. trichomonal infection. b. bacterial vaginosis. c. candidiasis. d. gonorrhea. e. cervical cancer. Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount. REF: p. 435 • The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide containing vaginal mucus suggests a. bacterial vaginosis. b. yeast infection. c. chlamydial infection. d. pregnancy. e. gonorrhea. A positive “whiff test” suggests bacterial vaginosis. REF: p. 435 • A fixed uterus may indicate a. adhesions. b. postmenopause. c. pregnancy. d. premenopause. e. a normal finding. The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions. REF: p. 437 • The assessment of which structure is not part of the bimanual examination? a. Cervix b. Bladder c. Uterus d. Ovaries e. Adnexa The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries. REF: p. 435 • The rectovaginal examination is an important component of the total pelvic examination because it a. is the most direct cervical examination route. b. is a more comfortable examination for the posthysterectomy patient. c. is an alternate source for cytology specimens. d. allows the examiner to reach almost 2.5 cm higher into the pelvis. e. provides better evaluation of the bladder. The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder. REF: p. 438 • Prominent labia minora are a normal finding in a. adolescents. b. menopausal women. c. newborns. d. pregnant women. e. postmenopausal women. Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent. REF: p. 439 • Swollen and bruised genitalia in a newborn are most likely related to a. a breech delivery. b. a congenital defect. c. an infection. d. maternal hormones. e. an enlarged clitoris. Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery. REF: p. 439 • The most common cause of a foul vaginal discharge in children is a(n) a. rectocele. b. foreign body. c. infection. d. ruptured hymen. e. accident. Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body. REF: p. 441 • A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vagina vault, you should first a. insert a pediatric vaginal speculum. b. place your hand firmly against the labia and spread your fingers. c. insert a cotton-tipped applicator and press down. d. pull the labia anteriorly and slightly to the side. e. place the child prone and in the fetal position. Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver. REF: p. 440 • A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with a. chronic masturbation. b. congenital defects. c. acute urinary tract infection. d. sexual abuse. e. malignancy. A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly. REF: p. 441 • When a woman is not sexually active, cervical cancer screening should begin a. at menarche. b. by age 15 years. c. by age 18 years. d. by age 21 years. e. by age 30 years. Women who are not sexually active should have their first examination by the age of 21 years. Women under age 21 should not be tested. REF: p. 437 • Softening of the uterine isthmus occurring between 6 and 8 weeks of pregnancy is the _____ sign. a. Homan b. McDonald c. Piskacek d. Hegar e. Chadwick Between the sixth and eighth weeks of pregnancy, the uterine isthmus softens, which is known as the Hegar sign. REF: p. 443 • Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy. a. 10 b. 16 c. 20 d. 24 e. 30 At 20 weeks of gestation, the fundal height reaches the level of the umbilicus. REF: p. 443 • During a pelvic examination for a postmenopausal woman, you would expect to assess a. a wider and longer vaginal vault. b. absence of vaginal wall rugation. c. a nonpalpable cervical os. d. a more mobile cervix. e. palpable ovaries. Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy. REF: p. 423 • What accommodations should be used in the position of a hearing-impaired woman for a pelvic examination? a. The patient should assume the “M” or “V” position. b. The patient should be in the diamond-shaped position. c. The head of the table should be elevated. d. The lithotomy position with obstetric stirrups should be used. e. The patient should be in the knee–chest position. The woman with a hearing impairment will need to see the clinician or an interpreter during the examination; therefore, her head should be elevated. REF: p. 449 • Asking the woman to close the introitus during a pelvic examination is a test for a. endometriosis. b. rectocele. c. cervical polyps. d. muscle tone. e. cystocele. Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing. REF: p. 430 • Which of the following is a normal component of physiologic vaginitis seen on a wet mount? a. Three to five white blood cells (WBCs) b. Clue cells c. Branching hyphae d. Spores e. Motile flagellates Up to three to five WBCs on a wet mount are within normal limits. REF: p. 457 • The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is a. homogeneous and gray with a low pH. b. scant and curdy with a low pH. c. profuse and frothy with a high pH. d. profuse and curdy with a low pH. e. bloody and thin with a high pH. Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5). REF: p. 457 • A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria or vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to a. swab for gonococcal infection and then dip her urine. b. obtain a surgical consult immediately. c. remove the foreign body. d. dip her urine and then swab for Chlamydia. e. diagnose ovarian cyst and schedule follow-up. The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test. REF: p. 461 • A cervical polyp usually appears as a a. grainy appearance at the ectocervical junction. b. bright-red soft protrusion from the endocervical canal. c. transverse or stellate scar. d. hard granular surface at or near the os. e. flesh-colored, firm protrusion at the cervical os. Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical canal. REF: p. 431 • Mittelschmerz may occur in which phase of the menstrual cycle? a. Menstrual b. Postmenstrual c. Ovulation d. Secretory e. Luteal Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month REF: p. 437 • What breast structure drains milk from each lobe onto the surface of the nipple? a. Alveolus b. Lactiferous duct c. Montgomery follicle d. Tail of Spence e. Coopers ligament The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple. REF: p. 351 • The largest amount of glandular breast tissue lies in the a. upper inner quadrant. b. lower inner c. tail of Spence. d. upper outer quadrant. e. lower outer. The greatest amount of glandular tissue in the breast lies in the upper outer quadrant. REF: p. 351 • For purposes of examination and communication of physical findings, the breast is divided into a. halves (upper and lower). b. thirds (left, middle, and right). c. four quadrants plus a tail. d. circles (six consecutive rings, each 1 inch farther away from nipple). e. radial portions 1 through 6. The breast is referenced according to five segments: four quadrants and a tail. REF: p. 351 • Contraction of breast smooth muscle results in a. benign breast lumps. b. emptying of milk ducts. c. nipple inversion. d. nipple tenderness. e. tension on the suspensory ligaments of Cooper. Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the milk ducts to empty. REF: p. 351 • Montgomery tubercles are most prominent in the breasts of a. men. b. patients with lung disease. c. adolescent girls. d. prepubertal girls. e. pregnant women. Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women. REF: p. 353 • Approximately 75% of women are menstruating by which Tanner stage of breast development? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5 About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5. REF: p. 352 • During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones? a. The amount of connective tissue increases. b. Epithelial secretory activity decreases. c. Alveoli increase in size and number. d. Vascularization decreases. e. Lactiferous ducts diminish. Breast changes during pregnancy include lactiferous duct proliferation, an increase in alveoli and glandular tissue that displaces connective tissue, and an increase in mammary vascularization. As a result, the breasts are larger, softer, and looser with a blue venous network visible through the skin. REF: p. 353 • Milk production usually begins during which period? a. At conception b. During the first trimester of pregnancy c. During the second trimester of pregnancy d. At delivery e. 2 to 4 days after delivery Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days. REF: p. 353 • Which breast change is typical after menopause? a. Thickening of the inframammary ridge b. Hypertrophy of glandular tissue c. Increase in number of lactiferous ducts d. Reduction of fat deposits e. Shortening of Cooper’s ligaments After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax. REF: p. 353 • In a woman complaining of a breast lump, it is most important to ask about a. its relationship to menses. b. weight gain. c. sleep patterns. d. immunization status. e. alcohol consumption. Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation. REF: p. 363 • When conducting a clinical breast examination, the examiner should a. forgo the examination if the patient has had a recent mammogram. b. keep the patient covered to respect modesty. c. dim the lights to minimize anxiety. d. inspect both breasts simultaneously. e. begin with palpation of the breasts. Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color. REF: p. 357 • A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer? a. Drinking three glasses of wine per week b. Early menopause c. Nulliparity d. Late menarche e. Young age at birth of first child. Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily. REF: p. 354 • If your patient has nipple discharge, you will most likely need a a. Vacutainer tube. b. glass slide and fixative. c. specimen jar with formaldehyde. d. tape strip to test pH. e. needle and syringe. A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose. REF: p. 355 • To begin the clinical breast examination (CBE) for a man, ask him to a. recline on the table with his arms overhead. b. sit with his arms hanging at his sides. c. sit with his hands on his hips. d. stand with his arms clasped behind his back. e. stand leaning forward. Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for both men and women. REF: p. 355 • Inspection of the breasts usually begins with the patient in which position? a. Lateral b. Sitting c. Standing d. Supine e. Prone Inspection begins with the patient in a sitting position with arms hanging loosely at the sides. REF: p. 355 • While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should a. note the finding in the patient’s record. b. ask the patient if she has ever had breast cancer. c. tell the patient to get a mammogram as soon as possible. d. tell the patient to get a mammary sonogram as soon as possible. e. tell the patient to stop caffeine intake. Often one breast is slightly larger than the other. This is a normal variation, and no further intervention is required. REF: p. 365 • Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast carcinoma? a. Convex or conical shape b. Skin dimpling or retraction c. Pendulous and loose breasts d. Unequal shape or contour e. Lifelong inverted nipple Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development. REF: p. 356 • Venous patterns on breasts are suggestive of pathology when they are a. bilaterally visible. b. seen in obese patients. c. unilateral. d. observed during pregnancy. e. associated with a long-standing unchanging nevus. Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. Nevi that are long-standing, unchanging, or nontender are of little concern. REF: p. 356 • Which of the following is a common benign variation in the breasts of a pregnant woman? a. Unilateral leakage of bloody fluid b. Bilateral leakage of bloody fluid c. Bilateral pronounced venous patterns d. Reddened areas in the tail of Spence e. Peau d’orange appearance Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings. REF: p. 364 • A 23-year-old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to a. instruct her that this is a side effect of birth control injection therapy. b. suggest pregnancy testing. c. question her use of tanning beds. d. schedule an appointment with a surgeon. e. recommend she remove caffeine from her diet. In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary. REF: p. 364 • In patients with breast cancer, peau d’orange skin is often first evident a. in the axilla. b. in the upper inner quadrant. c. on or around the nipple. d. at the inframammary ridge. e. in the tail of Spence. The areola is the most common initial site to visualize peau d’orange skin. REF: p. 356 • A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a a. normal finding. b. sign of carcinoma. c. skin disease. d. symptom of malnutrition. e. sign of late menarche. Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage. REF: p. 356 • Which of the following is most likely to be a variation of minor consequence? a. Bilateral nipple inversion b. Fixed stonelike nodule c. Serous nipple drainage d. Unequal nipple axis e. Paget disease of the breast Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue. REF: p. 356 • Recent unilateral inversion of a previously everted nipple suggests a. obesity. b. cancer. c. benign breast disease. d. pregnancy. e. mastitis. Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition. REF: p. 357 • Which condition is more common in African American women than in white women? a. Light areolae b. Nipple inversion c. Retracted areolae d. Supernumerary nipples e. Nipple and areolar colors do not match. The incidence of supernumerary nipples is higher in African American women than in white women. REF: p. 357 • When palpating breast tissue, the examiner should use the _____ at each site. a. fingertips b. finger pads c. palms of the hands d. ulnar surface of the hands e. thumbs The finger pads are used for breast palpation because they are more sensitive than the fingertips. REF: p. 361 • Documentation of a breast mass location is a. according to illustration, without a narrative. b. according to clock positions from the nipple. c. measured with calipers from the nipple. d. measured in centimeters from the sternal notch. e. measured in centimeters from the axilla. Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well. REF: p. 361 • If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient’s breast, you should a. ask the patient if she has a history of breast cancer. b. refer the patient for biopsy. c. ask the patient to have a mammogram as soon as possible. d. record the finding in the patient’s record. e. tell the patient to stop drinking alcohol. The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action. REF: p. 363 • During palpation of a 30-year-old woman’s breast, she complains that the procedure is painful. You suspect that this may be because she is a. premenstrual. b. a heavy smoker. c. perimenopausal. d. multiparous. e. an alcoholic. Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow. REF: p. 363 • A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to a. apply an Ace wrap compression bandage for 6 hours a day. b. return for evaluation in 6 months if the problem persists. c. obtain a surgical referral for needle biopsy. d. discontinue all contact sports. e. administer urine screen for illicit drugs. Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential. REF: p. 363 • The tail of Spence extends a. into the midclavicular region. b. toward the supraclavicular area. c. down into the inframammary ridge. d. into the axillae. e. along the sternal border. The tail of Spence extends from the upper outer breast quadrant into the axillae. REF: p. 351 • To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with a. her arms straight alongside her body. b. both arms overhead with her palms upward. c. her hands clasped just above her umbilicus. d. one arm overhead and a pillow under her shoulder. e. both hands pressed against her hips. Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder. REF: p. 360 • Palpation of the nipple is done by a. depressing it behind the areola. b. pressing it against the rib cage. c. pulling it outward and releasing it. d. rolling it in a clockwise motion. e. inverting the nipple. At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination. REF: p. 361 • When examining axillary lymph nodes, the patient’s arm is a. raised full above the head. b. extended at the side. c. pressed against the hip. d. crossed over the chest. e. flexed at the elbow. To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla. REF: p. 360 • Lymphatic flow of the breast primarily drains a. inferiorly toward the abdomen. b. laterally toward the corresponding arm. c. radially. d. medially toward the sternum. e. inferomedially toward the xiphoid. Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics. REF: p. 352 • The greatest concern for breast cancer is when you palpate _____ nodes. a. anterior cervical b. subscapular c. brachial d. supraclavicular e. internal mammary The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant. REF: p. 360 • You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should a. apply lotion to your hands. b. use both hands simultaneously. c. ask the patient to press both palms together. d. ask the patient to lower her shoulder on that side. e. ask the patient to turn her head toward that side. Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa. REF: p. 360 • The mother of a newborn boy tells you that her baby’s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the a. enlargement and leaking are caused by maternal hormones and will likely resolve without treatment. b. infant may have a congenital heart defect. c. infant may need genetic testing. d. infant needs ultrasonography of the breasts to exclude a pathologic cause. e. infant may have mastitis. Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months. REF: p. 363 • Male gynecomastia associated with illicit or prescription drug use can be expected to a. lessen when the body becomes accustomed to the drug. b. resolve after the drug is discontinued. c. leave permanent breast enlargement when the drug is discontinued. d. cause purulent drainage if left untreated. e. lead to an increased risk of breast cancer. Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention. REF: p. 364 • A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic breasts bilaterally. You should advise the patient to a. massage gently and continue nursing. b. apply warm compresses and stop nursing. c. monitor her temperature and restrict fluids. d. sleep with a bra and wash her breasts with antibacterial soap. e. stop nursing and restrict fluids. This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection. REF: p. 365 • You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with a. fibroadenoma. b. Paget disease. c. cancer. d. mammary duct ectasia. e. fibrocystic changes. Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women. REF: p. 365 • Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed a. retention cyst. b. case of Paget disease. c. supernumerary nipple. d. fat necrosis. e. Montgomery tubercle. Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples. REF: p. 357 • The sensitivity of clinical breast exam (CBE) in detecting breast cancer ranges from a. 10% to 20%. b. 20% to 39%. c. 40% to 69%. d. 70% to 89%. e. 88% to 99%. The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography. REF: p. 358 • The structure that carries oxygenated blood to the body from the left ventricle is the a. aorta. b. pulmonary artery. c. pulmonary vein. d. superior vena cava. e. inferior vena cava. The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior and inferior venae cavae carry blood from the upper and lower body to the right atrium. REF: p. 332 • The arterial pulse is produced by a. atrial contraction. b. ventricular systole. c. peripheral vascular resistance. d. diastolic pressure. e. atrial relaxation. Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is the function of peripheral vascular resistance. REF: p. 336 • The characteristics of arterial pulses are directly affected by all of the following except a. the volume of blood ejected. b. peripheral arterial resistance. c. venous valvular competence. d. blood viscosity. e. distensibility of aorta. Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart. REF: p. 336 • The level at which the jugular venous pulse is visible gives an indication of a. mitral valve efficiency. b. aortic valve efficiency. c. stroke volume. d. left ventricular pressure. e. right atrial pressure. The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart. REF: p. 336 • The most prominent component of the jugular venous pulse is the a. a wave. b. c wave. c. v wave. d. x slope. e. y slope. The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction. REF: p. 336 • In newborn infants, closure of the ductus arteriosus usually occurs a. before the initiation of labor. b. 12 to 14 hours after birth. c. after 7 days of life. d. between the second and third month. e. during the toddler period. The ductus arteriosus closes usually within the first 12 to 14 hours of life. REF: p. 337 • Blood pressure normally decreases during what period? a. Fertilization b. First trimester of pregnancy c. Second trimester of pregnancy d. Third trimester of pregnancy e. During labor and delivery Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the patient is lying in the supine position. REF: p. 337 • During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings a. are usual conditions during pregnancy. b. indicate a need for hospitalization. c. indicate the need for amniocentesis. d. suggest that she is having twins. e. suggest that she never lie on her side. Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. The occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symptoms. REF: p. 337 • Vascular changes expected in older adults include a. loss of vessel elasticity. b. decreased peripheral resistance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. e. increased vasomotor tone. With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure. REF: p. 337 • The amplitude of pulses is recorded on a(n) a. Likert scale of absent to bounding. b. numerical scale of 0 to 4. c. alphabetic scale of A to E. d. descriptive scale of mild, moderate, and severe. e. graded scale of I to VI. The amplitude of pulses is recorded on a numeric scale of 0 to 4: 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding. REF: p. 340 • Which of the following statements is true regarding the examination of peripheral arteries? a. The thumb should never be used to assess pulses. b. Palpate at least one pulse in each extremity, usually the most proximal one. c. The pulses are most readily felt over arteries that lie over bones. d. Extremity pulses do not normally generate waveforms. e. The pads of the fourth and fifth digits of the examiner’s hands are the most sensitive. The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform). REF: p. 338 • Which arterial pulse is most useful in evaluating heart activity? a. Femoral b. Radial c. Temporal d. Brachial e. Carotid Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity. REF: p. 338 • A pulsation that is diminished to the point of being barely palpable would be graded as a. 0. b. 1. c. 2. d. 3. e. 4. A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4. REF: p. 340 • The term claudication refers to a. pain from muscle ischemia. b. lack of palpable pulsations. c. visible extremity changes of arterial occlusion. d. numbness and tingling in toes and fingers. e. constriction or narrowing of a vessel. Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. REF: p. 340 • Conduction system impairment should be suspected if an irregular heartbeat is a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding. A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration. REF: p. 340 • In which location would carotid bruits best be heard? a. Posterior cervical triangle b. Anterior margin of the sternocleidomastoid muscle c. Over the aortic valve d. At the angle of the mandible e. Just anterior to the ear Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. REF: p. 342 • You are examining Mr. S., a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency? a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of extremity in contrast to other body parts d. Thin atrophied skin e. Full superficial veins with rapid filling An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling. REF: p. 340 • A sound similar to a murmur that is heard over arteries is a a. thrill. b. hum. c. friction rub. d. bruit. e. heave. A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system. REF: p. 340 • In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is a. color change. b. edema. c. pain with walking. d. pain with palpation. e. paralysis. Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion. REF: p. 344 • To assess a patient’s jugular veins, he or she should first be placed in which position? a. Supine b. Semi-Fowler c. Upright d. Left lateral recumbent e. Leaning forward To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated. REF: p. 342 • Observation of hand veins can facilitate assessment of a. mitral valve competency. b. stoke volume. c. right heart pressure. d. pulse pressure. e. left heart pressure. Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the mid-axillary line (level of the heart) and the level of the collapsed hand veins. REF: p. 343 • You are assessing Mr. Z.’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as a. 1 . b. 2 . c. 3 . d. 4 . e. 5 . Pitting edema to 6 mm represents a 3 rating. This edema is noticeably deep and may last more than 1 minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1 ) through worse (4 ). REF: . p344 • If pitting edema is unilateral, you would suspect occlusion of a a. lymphatic duct. b. major vein. c. surface capillary. d. superficial artery. e. deep artery. If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema. REF: p. 344 • Thrombosis of a leg vein should be suspected if the patient feels calf pain a. after running a short distance. b. on dorsiflexion of the foot. c. on extending a flexed thigh. d. while wearing high-heeled shoes. e. flexing the knee. Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign. REF: p. 344 • Which of the following statements is most accurate in describing hepatic jugular reflux? a. It is an accurate indicator of heart failure. b. It is exaggerated in patients with right heart failure. c. It is normal when patients are sitting up straight. d. It should be absent in older patients with heart failure. e. It never elevates the jugular venous pressure (JVP) in patients without heart failure. Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure. REF: p. 343 • You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to a. record this measurement as less than 9 cm H2O pressure. b. record this measurement as more than 9 cm H2O pressure. c. confirm that the pulsations decrease with inspirations. d. confirm that the pulsations increase with inspirations. e. place the patient in the supine position and recheck. Confirmation of assessing venous pressure rather than a carotid wave pulse is necessary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected. REF: p. 343 • A bounding pulse in an infant may be associated with a. patent ductus arteriosus. b. coarctation of the aorta. c. decreased cardiac output. d. peripheral vaso-occlusion. e. painful, swollen extremities. A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion. REF: p. 345 • In infants or small children, a capillary refill time of 4 seconds a. is normal. b. indicates hypervolemia. c. indicates dehydration or hypovolemic shock. d. indicates renal artery stenosis. e. indicates venous occlusion. Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill will be greater than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration. REF: p. 345 • A venous hum heard over the internal jugular vein of a child a. usually signifies untreatable illness. b. usually has no pathologic significance. c. usually requires surgical intervention. d. must be monitored until the child is grown. e. usually indicates dehydration. A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. REF: p. 345 • In pregnancy, blood pressure is lowest a. at conception. b. during the first trimester. c. during the second trimester. d. during the third trimester. e. at the time of delivery. The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels. REF: p. 337 • An idiopathic spasm of arterioles in the digits is called a. arteriosclerosis obliterans. b. giant cell arteritis. c. arteriovenous fistula. d. peripheral arterial aneurysm. e. Raynaud disease. Raynaud phenomenon is an idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries. REF: p. 347 • A major risk factor for arterial embolic disease is a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy. e. constrictive pericarditis. Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. REF: p. 347 • In children, coarctation of the aorta should be suspected if you detect a. a delay between the radial and femoral pulses. b. a simultaneous radial and femoral pulse. c. an absent femoral pulse on the left. d. bilateral absence of femoral pulses. e. equal blood pressures in the arms and legs. Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. REF: p. 348 • Kawasaki disease is suspected when assessments of a child reveal a. conjunctival injection, strawberry tongue, and edema of the hands and feet. b. conjunctival infection, lymphadenopathy, and a vesicular rash. c. low-grade fever, strawberry tongue, and edema of the hands and feet. d. dermatomal bullae rash, high fever, and cyanotic hands and feet. e. recent streptococcal pharyngitis, vesicular rash, and geographic tongue. Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affecting young males more often than females. Findings may include fever, conjunctival injection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous nonvesicular rashes. REF: p. 349 • Cranial Nerves (1-6) 1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens • Cranial Nerves (7-12) 7. Facial 8. Vestbulocochlear (Auditory) 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal • CN I - Olfactory Assessment Test patient's ability to smell (coffee, vanilla, peppermint). • CN II - Optic Assessment o Snellen eye Chart o Examine visual fields o Confrontation • CN III, IV, VI Oculomotor, Trochlear, Abducens o pupil size, shape, ptosis o Shine light from side to gauge pupils reaction to light. o EOM exam o Convergence and accomodation • CN V - Trigeminal o Corneal reflex o look for blink in both eyes o facial sensation o Motor - pt opens mouth, clenches teeth • CN VII - Facial o Facial droop o pt looks up and wrinkles forehead o pt shuts eyes tightly, compare each side o frown, show teeth, puff out cheeks • CN VIII - Vestibulocochlear (hearing) o ask patient if they can hear you rubbing your fingers together o Weber's Test o Rinne's Test • CN IX, X: Glossopharyngeal, Vagus o Voice: hoarse or nasal. o Pt. swallows, coughs (bovine cough: recurrent laryngeal). o Examine palate for uvular displacement. (unilateral lesion: uvula drawn to normal side). o Pt says "Ah": symmetrical soft palate movement. o Gag reflex [sensory IX, motor X]: o • Stimulate back of throat each side. o • Normal to gag each time. • CN XI: Accessory o From behind, examine for trapezius atrophy, asymmetry. o Pt. shrugs shoulders (trapezius). o Pt. turns head against resistance: watch, palpate SCM on opposite side. • CN XII: Hypoglossal o Listen to articulation. o Inspect tongue in mouth for wasting, fasciculations. o Protrude tongue: unilateral deviates to affected side. • The autonomic nervous system coordinates which of the following? a. High-level cognitive function b. Balance and affect c. Internal organs of the body d. Balance and equilibrium e. Emotions and behavior The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function. REF: p. 544 • A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the a. peritoneum. b. mediastinum. c. linea alba. d. mesentery. e. pleura. ANS: A The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover. REF: p. 370 Definition • What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. Duodenum b. Ileum c. Jejunum d. Falciform ligament e. Pylorus The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine. REF: p. 372 • Peristalsis of intestinal contents is under the control of a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. e. cerebellum. The movement of food and digestive products is regulated by the autonomic nervous system. REF: p. 372 • The esophagus travels a route from a. anterior to the trachea through the mediastinal cavity. b. lateral to the trachea through the diaphragm. c. left of the trachea through the peritoneum. d. the anterior trachea through the cardiac orifice. e. behind the trachea through the mediastinal cavity. The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters into the stomach. The esophagus connects the pharynx to the stomach. REF: p. 372 • Which organ is part of the alimentary tract? a. Pancreas b. Stomach c. Gallbladder d. Liver e. Spleen The term alimentary tract refers to the continuous tract from the mouth, esophagus, stomach, small intestine, large intestine, and anus. REF: p. 372

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