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NURS 6512 exam 3CA All answers Correct

NURS 6512 exam 3CA • The superior most part of the stomach is the a. body. b. fundus. c. pylorus. d. cardiac orifice. e. pyloric orifice. The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus. REF: p. 372 • Which of the following is true regarding the stomach? a. It lies in the lower abdominal cavity. b. It secretes gastric lipase that serves to digest protein. c. Very little absorption takes place in the stomach. d. The stomach produces most of the body’s bile. e. Pancreatic enzymes directly enter the stomach. The stomach lies across the upper abdomen, secretes pepsin that digests protein and gastric lipase that emulsifies fats, and has a very small role in the absorption of nutrients. Secretions from the liver and pancreas enter the duodenum. REF: p. 372 • The appendix is an extension of the a. ileum. b. cecum. c. ascending colon. d. transverse colon. e. descending colon. The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum. REF: p. 372 • When palpating the abdomen, you should note whether the liver is enlarged in the a. left upper quadrant. b. midepigastric region. c. periumbilical area. d. right upper quadrant. e. right lower quadrant. The liver is located in the right upper quadrant of the abdomen. REF: p. 372 • One major function of the liver is to a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin. The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body. REF: p. 373 • The majority of nutrient absorption takes place in the a. stomach. b. small intestine. c. cecum. d. transverse colon. e. descending colon. Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function is water reabsorption. REF: p. 372 • The major function of the large intestine is a. water absorption. b. food digestion. c. carbohydrate absorption. d. mucous absorption. e. glycogen breakdown. The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus. REF: p. 372 • Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the a. spleen. b. kidney. c. liver. d. pancreas. e. gallbladder. The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea. REF: p. 373 • Contraction of the gallbladder propels bile into the a. stomach. b. duodenum. c. jejunum. d. ileum. e. cecum. With contraction of the gallbladder, bile is excreted into the duodenum. REF: p. 373 • Which abdominal organs also produce hormones and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Stomach and spleen d. Gallbladder and pancreas e. Pancreas and kidney The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin. REF: p. 373 • Which organ(s) are located in the retroperitoneal space? a. Kidneys b. Lungs c. Spleen d. Gallbladder e. Liver The kidneys are located in the retroperitoneal space, lying behind the abdominal cavity and beside the abdominal aorta. REF: p. 373 • Mrs. G is 7 months’ pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as a. decreased movement through the colon and increased water absorption from stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and less nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. e. increased absorption of nutrients and water in the colon. Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy. REF: p. 374 • The most pronounced functional change of the gastrointestinal (GI) tract in older adults is a. decreased hydrochloric acid production. b. increased motility. c. decreased bile absorption. d. decreased motility. e. increased saliva secretion. A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults. REF: p. 375 • The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it a. only affects the GI tract. b. is one cause of malabsorption syndrome. c. is a curable condition with medical intervention. d. is the most frequent cause of diarrhea in general practice. e. is a common genetic disorder. Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns. REF: p. 377 • Infants born weighing less than 1500 g are at higher risk for a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. cystic fibrosis. e. pancreatitis. Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis. REF: p. 377 • Inspection of the abdomen should begin with the patient supine and the examiner a. seated on the patient’s right side. b. standing at the foot of the table. c. standing at the patient’s left. d. walking around the table. e. seated on the patient’s left side. This preferred initial position allows tangential viewing of the abdomen for improved assessment of abdominal contour. REF: p. 377 • Before performing an abdominal examination, the examiner should a. ascertain the patient’s HIV status. b. have the patient empty his or her bladder. c. don double gloves. d. completely disrobe the patient. e. uncover only the painful areas of the abdomen. ANS: B The patient should empty the bladder to ensure an accurate examination of organs as well as to provide comfort for the patient. REF: p. 377 • Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach e. Liver The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus. REF: p. 379 • Murphy's Sign pain on inspiration .Examiner's fingers are placed on the RUQ at the gallbladder, a finding associated with acute cholecystitis • When examining a patient with tense abdominal musculature, a helpful technique is to have the patient a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. e. fully extend the legs. To help relax the abdominal musculature, it is helpful to place a small pillow under the patient’s head and under slightly flexed knees. The other choices increase muscle flexion. REF: p. 383 • You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n) a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. e. incisional hernia. A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity. REF: p. 395 • What condition is associated with striae that remain purplish? a. Cushing disease b. Diastasis recti c. Liver cirrhosis d. Recent pregnancy e. Intraabdominal bleeding Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish. REF: p. 379 • Valgus sign Outward angulation of distal segment of bone or joint- medial meniscus or medial collateral ligament damage (ex: football injury) • Visible intestinal peristalsis may indicate a. normal digestion. b. intestinal obstruction. c. increased pulse pressure of aorta. d. aortic aneurysm. e. paralytic ileus. Peristalsis is not usually visible and when detected may indicate an intestinal obstruction. REF: p. 381 • After thorough inspection of the abdomen, the next assessment step is to a. percuss. b. palpate nonpainful areas. c. auscultate. d. perform a rectal examination. e. palpate painful areas. Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first. REF: p. 381 • Auscultation of borborygmi is associated with a. gastroenteritis. b. peritonitis. c. satiety. d. paralytic ileus. e. stenotic arteries. Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as hunger does. Vascular bruits are not associated with borborygmi. REF: p. 381 • Peritonitis often produces bowel sounds that are a. decreased. b. increased. c. high pitched. d. absent. e. accentuated. Decreased bowel sounds occur with peritonitis and paralytic ileus. REF: p. 381 • A patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low-grade fever attributed to eating some “bad food” 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis? a. Malaise b. Low-grade fever c. Hypoactive bowel sounds d. Soft, rounded abdomen e. Abdominal pain Gastroenteritis is more consistent with findings of crampy abdominal pain, borborygmi, nausea and vomiting, diarrhea, fever, and no abdominal distention. Hypoactive bowel sounds are not expected with gastroenteritis. A firm, distended abdomen suggests an obstruction. REF: p. 381 • An examiner can recognize a friction rub in the liver by a sound that is a. clicking, gurgling, and irregular. b. high pitched and associated with respirations. c. loud, prolonged, and gurgling. d. soft, low-pitched, and continuous. e. low pitched, tinkling, and unrelated to respirations. An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations. REF: p. 381 • To correctly document absent bowel sounds, one must listen continuously for a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes. e. 10 minutes. Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. REF: p. 381 • Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the a. descending aorta. b. lower liver border. c. medial border of the spleen. d. upper right kidney ridge. e. stomach. Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border more than 2 to 3 cm signifies hepatomegaly. REF: p. 381 • When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Borborygmi e. Venous hum Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds. REF: p. 381 • Percussion of the abdomen begins with establishing a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants. e. bladder fullness. Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. REF: p. 381 • To assess for liver enlargement in an obese person, you should a. use the hook method. b. test for cutaneous hypersensitivity. c. auscultate using the scratch technique. d. attempt palpation during deep exhalation. e. have the patient lean over at the waist. If the abdomen is obese or distended or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver. Cutaneous hypersensitivity is a sign of peritonitis and does not contribute to determining liver size. REF: p. 386 • An umbilical assessment in the newborn that is of concern is a. a thick cord. b. an umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. e. visible nondistended superficial veins. What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants. REF: p. 394 • Failure to pass a meconium stool in the first 24 hours after birth along with abdominal distention is often the first sign of a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. e. Wilms tumor. Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. REF: p. 411 • When palpating the aorta, a prominent lateral pulsation suggests a. aortic aneurysm. b. normal pulsation. c. renal artery fistula. d. vena cava varicosity. e. coarctation. Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm. REF: p. 388 • A patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course? a. Positive psoas sign b. Positive McBurney sign c. History of periumbilical pain d. Rebound tenderness e. Obturator muscle test Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess. REF: p. 393 • When using the bimanual technique for palpating the abdomen, you should a. push down with the bottom hand and the other atop. b. push down with the top hand and the other atop. c. place hands side by side and push equally. d. place one hand anteriorly and the other posteriorly squeezing the hands together. e. make a fist with the top hand and strike the bottom hand. The bimanual technique uses one hand on top of the other with the top hand pushing down while the bottom hand against the abdomen is used for sensing. REF: p. 394 • A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is a. “My urine has been bright yellow.” b. “I have had fever and chills for 2 days.” c. “I also have a headache and neck ache.” d. “My left testicle and shoulder hurt as well.” e. “I have had flatulence and foul-smelling urine.” Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder). REF: p. 391 • Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with a. peptic ulcer disease. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. e. diverticulitis. No choice other than diverticulitis has all of these presenting symptoms. REF: p. 390 • A 45-year-old man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a(n) a. elevated white blood cell count. b. decreased potassium level. c. positive Helicobacter pylori result. d. increased urine specific gravity. e. folate deficiency. The patient’s presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori. REF: p. 401 • A 51-year-old woman calls with concerns of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to a. use topical over-the-counter hemorrhoid treatment for 1 week. b. exercise and eat more fiber. c. come to the laboratory for a stool guaiac test. d. eat six small meals a day. e. go to the emergency department for a barium enema. Blood in the stools is an abnormal finding that should never be ignored even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years. REF: p. 404 • Patients presenting with ascites, jaundice, cutaneous spider veins, and nonpalpable liver exhibit signs of a. cholecystitis. b. pancreatitis. c. inflammatory bowel disease. d. diverticulitis. e. cirrhosis. Jaundice is a result of excessive bilirubin that can result from cholecystitis, pancreatitis, or liver problems. Cirrhosis presents with additional symptoms of ascites, cutaneous spider veins, and a nonpalpable liver as scarring progresses. REF: p. 404 • A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured? a. Gallbladder b. Liver c. Spleen d. Stomach e. Colon Spleen laceration or rupture is always suspected with abdominal injury because of its anatomic location. The patient’s presenting symptoms confirm this suspicion. REF: p. 407 • Costovertebral angle tenderness should be assessed whenever you suspect the patient may have a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception. Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. REF: p. 408 • Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the ureter. What condition will be documented in this patient’s health record? a. Glomerulonephritis b. Hydronephrosis c. Pyelonephritis d. Renal abscess e. Renal artery emboli Hydronephrosis is the dilation of the renal pelvis from back pressure of urine that cannot flow past an obstruction in the ureter. REF: p. 408 • The most common congenital anomaly of the gastrointestinal tract is a. biliary atresia. b. meconium ileus. c. intussusception. d. Meckel diverticulum. e. pyloric stenosis. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. REF: p. 412 • Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe’s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe’s symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis e. Necrotizing enterocolitis Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age. REF: p. 410 • A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child’s diaper. Nephroblastoma is likely for this child when your physical examination of the abdomen reveals a(n) a. fixed mass palpated in the hypogastric area. b. tender, midline abdominal mass. c. olive-sized mass of the right upper quadrant. d. nontender, slightly moveable, flank mass. e. sausage-shaped mass in the left upper quadrant. A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension; fever; malaise; and a firm, nontender mass deep within the flank that is only slightly movable and is usually unilateral. REF: p. 413 • A 1-month-old boy has been vomiting for 2 weeks. How is this symptom of gastroesophageal reflux disease (GERD) and pyloric stenosis further differentiated in this child’s assessment? a. Vomiting becomes projectile with GERD. b. The infant has regurgitation with pyloric stenosis. c. An olive-sized mass of the right upper quadrant (RUQ) occurs with GERD. d. Normal stools are expected with pyloric stenosis. e. The fontanel becomes sunken with pyloric stenosis. With pyloric stenosis, vomiting becomes projectile, and a small olive-sized mass is palpable in the RUQ; the infant is usually hungry again soon after vomiting, and because little or no food is reaching the intestines, the infant has fewer, smaller stools. The child fails to thrive and has signs of dehydration. These signs are not associated with GERD. Regurgitation can be present with either disease. REF: p. 410 • Urinary incontinence that occurs from the inability to hold urine when the stimulus to urinate is perceived is called _____ incontinence. a. paralytic b. urge c. overflow d. functional e. stress Urge incontinence is the inability to delay urination when the urge to void occurs. REF: p. 415 • In older adults, overflow fecal incontinence is commonly caused by a. malabsorption. b. parasitic diarrhea. c. Meckel diverticulum. d. fistula formation. e. fecal impaction. Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool. REF: p. 415 • Fluid that lubricates articular cavities is called a. blood. b. synovial fluid. c. mucus. d. cerumen. e. marrow. Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. REF: p. 501 • Bones around a joint are held together by a. synovial membranes. b. ligaments. c. muscles. d. cartilage. e. tendons. Bones are held together within a joint by ligaments. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber. REF: p. 501 • Bones are attached to muscles by a. synovial membranes. b. ligaments. c. muscles. d. cartilage. e. tendons. Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts as an insulator for bones in joints. REF: p. 501 • The elbow joint that allows for flexion and extension in one plane represents a type of _____ joint. a. articulated b. ball and socket c. hinge d. pivot condyloid e. saddle A hinge joint allows for flexion and extension in one plane. A condyloid joint allows flexion and extension in two planes. A ball and socket joint allows movement in all planes. An articulated joint means simply that the joint allows movement. A saddle joint allows motion in two planes at right angles to each other but no axial rotation. REF: p. 505 • Spinal vertebrae are separated from each other by a. bursae. b. tendons. c. disks d. ligaments. e. synovial fluid. Except for sacral vertebrae, the spinal vertebrae are separated from one another by fibrocartilaginous disks. REF: p. 505 • The glenohumeral joint is the other name for the a. elbow. b. hip. c. wrist. d. scapula. e. shoulder. The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and the scapula. REF: p. 505 • The joint where the humerus, radius, and ulna articulate is the a. wrist. b. elbow. c. shoulder. d. sternum. e. clavicle. The elbow is the site where the humerus, radius, and ulna meet. The shoulder is made up of the humerus and scapula. The wrist is made up of the radius and the carpal bones of the hand. The sternum connects to the clavicles and ribs. The clavicle connects to the scapula but not the humerus. REF: p. 505 • The articulation of the radius and carpal bones is the a. wrist. b. elbow. c. shoulder. d. clavicle. e. digits. The joint composing the radius and carpal bones is called the wrist. REF: p. 505 • The cruciate ligaments within the knee provide for a. anterior and posterior stability. b. medial and lateral stability. c. movement on one plane. d. pivoting and rotation. e. shock absorption. The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption. REF: p. 507 • Medial and lateral surfaces of the tibiotalar joint are protected by a. bursae. b. tendons. c. muscles. d. ligaments. e. synovial fluid. The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle. REF: p. 507 • The suprapatellar bursa separates the patella, quadriceps tendon, and muscle from the a. talus. b. fibula. c. femur. d. pelvis. e. tibia. The suprapatellar bursa separates the knee, the quadriceps, and muscle from the femur. REF: p. 507 • The tibia, fibula, and talus articulate to form the a. ankle. b. knee. c. hip. d. pelvis. e. forefoot. The tibia, fibula, and talus, or heel, join to form the ankle. REF: p. 507 • Long bones in children have growth plates known as a. epiphyses. b. epicondyles. c. synovium. d. fossae. e. diastasis. Epiphyses are the growth plates found in long bones in children. REF: p. 508 • Ligaments are stronger than bone until a. birth. b. infancy. c. adolescence. d. middle adulthood. e. old age. Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger. REF: p. 508 • Injuries to long bones and joints are more likely to result in fractures than in sprains until a. preschool age. b. school age. c. adolescence. d. early adulthood. e. middle adulthood. Fractures to long bones and joints are more common during growth years. During childhood and early adolescence, the epiphyseal growth plates are more easily injured than are the tougher ligaments. Growth is completed with the closure of the epiphyseal growth plates at about 20 years of age. REF: p. 508 • The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are caused by a. decreased mineral deposition. b. increased hormone secretion. c. uterine enlargement. d. gait changes. e. increased mineral resorption. Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus. REF: p. 508 • Skeletal changes in older adults are the result of a. increased bone deposition. b. increased bone resorption. c. tendons becoming more elastic. d. decreased bone deposition. e. decreased bone resorption. As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults. REF: p. 508 • The usual number of vertebrae is a. 23. b. 24. c. 25. d. 26. e. 27. The number of vertebrae that is most common is 24; as few as 11% of persons have 23, and almost 5% have 26. REF: p. 504 • Romberg Sign Loss of balance that occurs when closing the eyes , occurs with: o cerebellar ataxia o loss of proprioception o loss of vestibuar function • The family history for a patient with joint pain should include information about siblings with a. trauma to the skeletal system. b. chronic atopic dermatitis. c. genetic disorders. d. obesity. e. poor physical conditioning. An important history to obtain for a patient with joint pain would be family history of genetic disorders such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, or hypercalciuria. REF: p. 509 • Risk factors for sports-related injuries include a. competing in colder climates. b. previous fractures. c. history of recent weight loss. d. failure to warm up before activity. e. light body frame. Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports-related injuries. A light body frame is a risk factor for osteoporosis, not sports-related injuries. REF: p. 539 • Light skin and thin body habitus are risk factors for a. rheumatoid arthritis. b. osteoarthritis. c. congenital bony defects. d. osteoporosis. e. sports-related injuries. People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, bony defects, and sports-related injuries are not found to have a correlation with light skin and a small frame. REF: p. 510 • Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of a. adolescents. b. infants. c. older adults. d. middle adulthood. e. children. History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals or electrolytes, or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication. REF: p. 510 • The musculoskeletal examination should begin when a. the patient enters the examination room. b. during the collection of subjective data. c. when height is measured. d. when joint mobility is assessed. e. the remainder of the physical examination is completed. When the patient first walks in the room, the examiner should observe the gait and posture as part of the musculoskeletal examination. REF: p. 510 • Pain, disease of the muscle, and damage to the motor neuron may all cause a. bony hypertrophy. b. muscle crepitus. c. muscle hypertrophy. d. muscle wasting. e. claudication. Muscle wasting is a consequence of pain from injury, pathology of the muscle, and injury to the motor neuron. REF: p. 510 • An increase in muscle tone is known as a. crepitus. b. effusion. c. tenosynovitis. d. atrophy. e. spasticity. An increase in muscle tone is referred to as spasticity. Crepitus, effusion, and tenosynovitis do not relate to muscle, and atrophy is wasting or a decrease in muscle mass. REF: p. 530 • Fasciculation occurs after injury to a muscle’s a. venous return. b. motor neuron. c. strength. d. tendon. e. fascia. Fasciculations can often by visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases. REF: p. 510 • The physical assessment technique most frequently used to assess joint symmetry is a. inspection. b. palpation. c. percussion. d. the use of joint calipers. e. auscultation. The assessment technique most commonly used to assess joint symmetry is inspection. Palpation, percussion, auscultation, and the use of joint calipers are not commonly used for this purpose. REF: p. 510 • A goniometer is used to assess a. bone maturity. b. joint proportions. c. range of motion. d. muscle strength. e. body fat. The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits. Muscle strength, bone maturity, body fat, and joint proportions are not measured by a goniometer. REF: p. 511 • When palpating joints, crepitus may be caused when a. irregular bony surfaces rub together. b. supporting muscles are excessively spastic. c. joints are excessively lax. d. there is excess fluid within the synovial membrane. e. there is muscle wasting. Crepitus is felt or heard when irregular bony surfaces rub together. Spastic muscles, muscle wasting, lax joints, and excess synovial fluid do not produce this grating sound upon palpation. REF: p. 510 • The temporomandibular joint is palpated a. under the mandible anterior to the sternocleidomastoid muscle. b. from inside the mouth. c. anterior to the tragus. d. at the mastoid process. e. above the mandible at midline. The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth. Under the mandible, above the mandible, and at the mastoid process do not describe the location of the temporomandibular joint. REF: p. 516 • Temporalis and masseter muscles are evaluated by a. having the patient frown. b. having the patient clench his or her teeth. c. asking patient to fully extend his or her neck. d. passively opening the patient’s jaw. e. having the patient shrug his or her shoulders. Having the patient bite down and clench his or her teeth is the method to examine the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver. REF: p. 516 • The strength of the trapezius muscle is evaluated by having the patient a. clench his or her teeth during muscle palpation. b. push his or her head against the examiner’s hand. c. straighten his or her leg with examiner opposition. d. uncross his or her legs with examiner resistance. e. adduct the arm. Having the patient apply opposite force with differing head motions, against the examiner’s hand, assesses the sternocleidomastoid and trapezius muscles. REF: p. 518 • Expected normal findings during inspection of spinal alignment include a. asymmetrical skinfolds at the neck. b. slight right-sided scapular elevation. c. convex lumbar curve. d. head positioned superiorly to the gluteal cleft. e. convex cervical curve. Spinal alignment is considered within normal limits when the patient’s head is positioned directly over the gluteal cleft. The skin folds should be symmetrical, the scapulae are at even heights, and both the cervical and lumbar curves are concave. REF: p. 518 • A common finding in markedly obese and pregnant women is a. kyphosis. b. lordosis. c. paraphimosis. d. scoliosis. e. phimosis. Bowing of the back, or lordosis, is more commonly found in pregnant women and obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults, and scoliosis is more commonly seen in teenagers. Phimosis and paraphimosis are penile conditions. REF: p. 533 • When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis? a. A prominent lumbar hump b. A prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips e. A gibbus Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist. REF: p. 519 • When the shoulder contour is asymmetrical and one shoulder has hollows in the rounding contour, you would suspect a. a dislocated elbow. b. a fractured scapula. c. a dislocated shoulder. d. muscle wasting. e. kyphosis. Asymmetrical contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting, a dislocated elbow, and a scapula fracture do not present with these symptoms. REF: p. 514 • Ulnar deviation and boutonniere deformities are characteristic of a. winged scapula. b. osteoarthritis. c. osteoporosis. d. congenital defects. e. rheumatoid arthritis. Deviation of the fingers toward the ulnar side and boutonniere deformities are classic symptoms of rheumatoid arthritis. Winged scapula, osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms. REF: p. 513 • A finding that is indicative of osteoarthritis is a. swan neck deformities. b. Bouchard nodes. c. ganglion cysts d. Heberden nodes. e. spindle-shaped fingers. Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities and spindle-shaped fingers; ganglion cysts are not associated with osteoarthritis. REF: p. 513 • A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign. a. Phalen b. Gower c. Homan d. Tinel e. Allis The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers. REF: p. 524 • Classic carpal tunnel syndrome would result in a. pain in the fourth and fifth digits. b. a negative Phalen test. c. reduced abduction of the thumb. d. palm tingling. e. a negative Tinel sign. Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, a positive Phalen sign, reduced abduction of the thumb, and sparing of palm tingling. The median half of the fourth digit and entire fifth digit are asymptomatic. REF: p. 524 • Excessive hyperextension of the knee with weight bearing may indicate a. advanced joint degeneration. b. early signs of gout. c. rotation of the Achilles tendon. d. a meniscal tear. e. weakness of the quadriceps muscle. Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. Gout, joint degeneration, Achilles tendon rotation, and meniscal tears do not cause hyperextension of the knee. REF: p. 521 • Arm length is measured from the acromion process through the a. olecranon joint to carpal thumb hinge. b. olecranon process to distal ulnar prominence. c. proximal radial prominence to distal joint. d. proximal ulnar joint to middle fingertip. e. olecranon process to the second fingertip. Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow (olecranon process) joint to the wrist (distal ulnar prominence). REF: p. 529 • A positive straight leg raise test usually indicates a. leg length discrepancy. b. knee instability. c. lumbar nerve root irritation. d. hip bursitis. e. improperly conditioned muscles. Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with the neck flexed and to raise one leg. If pain is felt, it is a positive straight leg raise result. The straight leg raise test does not assess leg length, knee stability, hip bursitis, or muscle condition. REF: p. 526 • The Thomas test is used to detect a. hip dislocation. b. unstable sacroiliac joints. c. knee instability. d. flexion contractures of the hip. e. asymmetry in the level of the iliac crests. The Thomas test requires the patient to lie supine with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. The Thomas test does not assess hip dislocation, sacroiliac joints, knee instability, or asymmetry of the iliac crests. REF: p. 526 • Which one of the following techniques is used to detect a torn meniscus? a. Phalen test b. McMurray test c. Thomas test d. Trendelenburg test e. Drawer test The McMurray test points to a meniscus tear. The Phalen test detects carpal tunnel syndrome. The drawer test detects an anterior cruciate ligament tear, the Thomas test detects hip contraction, and the Trendelenburg test detects weak hip abductor muscles. REF: p. 527 • When performing the drawer test, the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. grasp the lower leg with both hands and draw the tibia forward and then backward. d. apply varus stress with the foot planted. e. apply valgus stress after the leg is extended. The next step is to place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity. Draw the tibia forward, forcing the tibia to slide forward of the femur. Then push the tibia backward. Anterior or posterior movement of the knee greater than 5 mm in either direction is an unexpected finding. REF: p. 527 • Anterior cruciate ligament integrity is assessed via the _____ test. a. Lachman b. straight leg raise c. valgus stress d. Homan e. Thomas The Lachman test evaluates anterior cruciate ligament integrity. The straight leg raise test assesses nerve root damage, the valgus stress test assesses instability of the lateral and medial collateral ligaments, the Homan test assesses for blood clots in the legs, and the Thomas test is used to detect flexion contractures of the hips. REF: p. 528 • During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the _____ test. a. varus stress b. valgus stress c. Apley d. Lachman e. drawer The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus. REF: p. 528 • Term infants normally resist a. ankle dorsiflexion. b. McMurray test. c. forefoot adduction. d. knee extension. e. elbow flexion. Along with elbows and hips, newborns tend to resist extension of the knee; however, movements should be symmetrical. REF: p. 529 • What technique is performed at every infant examination during the first year of life to detect hip dislocation? a. Ballottement maneuvers b. Barlow-Ortolani maneuvers c. Range of motion d. Thomas McMurray assessment e. Trendelenburg test At every examination during an infant’s first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation and is signified by a clicking noise with the maneuver. REF: p. 530 • You note that a child has a positive Gower sign. You know that this indicates generalized a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy. e. scoliosis. Gower sign is generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee, pushing down on the thighs while trying to pull up the trunk. It is often associated with muscular dystrophy. REF: p. 532 • A 3-year-old boy is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of a. radial head subluxation. b. femoral anteversion. c. carpal tunnel syndrome. d. Osgood-Schlatter disease. e. osteomyelitis. The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid’s elbow. The symptoms are not consistent with femoral anteversion, carpal tunnel syndrome, Osgood-Schlatter disease, or osteomyelitis. REF: p. 542 • What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention? a. Carpal tunnel syndrome b. Osteitis deformans c. Radial head subluxation d. Talipes equinovarus e. Legg-Calvé-Perthes disease Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms of the syndrome. REF: p. 533 • A red, hot swollen joint in a 40-year-old man should lead you to suspect a. trauma. b. bursitis. c. gout. d. cellulitis. e. tenosynovitis. Gout is characterized as red, hot swollen joints, especially the great toe. Gout is commonly linked to men older than 40 years. REF: p. 536 • An adult with bowed tibias and a shortened thorax may have a. ankylosing spondylitis. b. Paget disease. c. rheumatoid arthritis. d. Dupuytren contracture. e. Sprengel deformity. Paget disease is characterized by bowed tibias, asymmetric skull, shortened chest, and susceptibility to fractures. REF: p. 537 • In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis typically exhibits a. metatarsus adductus. b. depression. c. sudden onset. d. less weakness and fatigue. e. pain most pronounced after periods of rest. One of the key differences between the symptoms of osteoarthritis and those of RA is that fatigue is uncommon in osteoarthritis patients. The joints of patients with RA are stiff after rest. REF: p. 538 • A 45-year-old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression? a. Positive straight leg raise result b. Positive Trendelenburg sign c. Negative Romberg test result d. Contralateral straight leg raise result e. Positive drawer test result This patient, according to the pattern of radiculopathy, has an L3–L4 injury to the right side. The most alarming finding would be crossover pain to the affected leg while raising the unaffected leg because this finding is more suggestive of herniation. REF: p. 526 • Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform a a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test. d. tibial torsion test. e. Lachman test. The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm results for hip dislocation. REF: p. 530 • A 7-year-old child who begins to limp and complains of persistent hip pain may have a. myelomeningocele. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis. e. congenital hip dislocation. Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by inadequate blood supply. Myelomeningocele, Dupuytren contracture, osteoarthritis, and congenital hip dislocation are not characterized by age group and these symptoms. REF: p. 541 • Dupuytren contracture affects the a. hip flexor muscle. b. plantar fascia. c. carpal tunnel. d. palmar fascia. e. rotator cuff. A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture. REF: p. 543 • A dowager hump is a. the hallmark of osteoporosis. b. pathognomic of scoliosis. c. indicative of tendonitis. d. characteristic of rickets. e. indicative of muscular dystrophy. Osteoporosis leads to vertebral compression and kyphotic bowing of the spine known as dowager’s hump. REF: p. 543

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