TEST BANK For Bates' Nursing Guide to Physical
Examination and History Taking, 3rd Edition By Beth
Hogan-Quigley; Mary Louis Palm
the objective observation of the patient begins with - ANSWER:the first moments of
the encounter and continues throughout the history and physical examination
the nonverbal cues collected during the general survey enable the nurse to -
ANSWER:select appropriate subjective questions for the individual patient to garner
more information
many factors are assessed, such as - ANSWER:-the patient's general appearance
-apparent state of health
-demeanor
-facial expression or affect
-grooming
-posture
-gait
-height
-weight
many factors contribute to the patient's makeup: - ANSWER:-genetic composition
-early illnesses
-socioeconomic status
-culture
-gender identity and expression
-nutrition
-degree of fitness
-mood state
-geographic location
-age cohort
the patient's status affects many of the characteristics you assess, including -
ANSWER:-blood pressure
-posture
-mood and alertness
-facial coloration
-dentition
-condition of the tongue and gingiva
-color of the nail beds
-muscle bulk
general survey--initial observations - ANSWER:physical appearance and apparent
state of health and mood
-overall appearance and apparent age
,-level of consciousness
-facial features and expressions
-demeanor and affect
-posture
-gait
-motor activity
-speech
-skin color and lesions
-dress and personal hygiene
what do the vital signs include? - ANSWER:-blood pressure
-heart rate
-respiratory rate
-temperature
although pain is a subjective finding, in order to ensure frequent pain assessment,
especially in a hospital or rehabilitation setting, pain has been labeled the -
ANSWER:"fifth vital sign"
pain assessment is commonly missed, and when pain is noted, it is often -
ANSWER:not effectively managed
pain is a frequent motivator for people to seek health care
depending on the clinical setting, some might also consider oxygen saturation using a
pulse oximeter, blood glucose level, or the Glasgow Coma Scale as the fifth vital sign
apparent state of health - ANSWER:try to make a general judgment based on
observations throughout the encounter
support with significant details
does the patient look his or her age? appear ill? fatigued?
level of consciousness - ANSWER:is the patient awake, alert, and responsive to you
and others in the environment? if not promptly assess the level of consciousness
orientation can be checked by asking about person, place, time, and situation
facial expression - ANSWER:observe the facial expression at rest, during
conversation, during the physical examination, and in interaction with others
watch closely for eye contact
is it natural? sustained and unblinking? quickly averted? absent?
are the movements of the face symmetric? is there ptosis? an uneven smile?
posture, gait, motor activity, and speech - ANSWER:what is the patient's preferred
posture? assess the patient before calling his or her name in the waiting room. how
is the patient sitting? does the position or nonverbal communication change when
you are in the room with the patient? patients often prefer sitting upright in left-
sided heart failure and leaning forward with arms braced in chronic obstructive
pulmonary disease (COPD)
, is the patient restless or quiet? how often does the patient change position? how
fast/slow are the movements? anxious patients appear agitated and restless.
patients in pain often avoid movement
is there any apparent involuntary motor activity? are some body parts immobile?
which ones? look for tremors, other involuntary movements, or paralysis
does the patient walk smoothly, with comfort, self-confidence, and balance or is
there a limp or discomfort, fear of falling, loss of balance, or any movement
disorder? does the patient use an assistive device to ambulate? cane? walker?
brace?
is the patient's speech articulate? garbled? rapid or slow?
fatigue - ANSWER:a nonspecific symptom with many causes
it refers to a sense of weariness or loss of energy that patients describe in various
ways "i don't feel like getting up in the morning" "i don't have any energy" "i just feel
blah" "I'm all done in" "i can hardly get through the day" "by the time i get to the
office i feel as if i've done a day's work"
because fatigue is a normal response to hard work, sustained stress, or grief, try to
elicit the life circumstances in which it occurs
fatigue unrelated to such situations requires further investigation
fatigue is a common symptom of depression and anxiety states, but also consider
infections (such as hepatitis, infectious mononucleosis, and tuberculosis); endocrine
disorders (hypothyroidism, adrenal insufficiency, diabetes mellitus); heart failure;
chronic disease of the lungs, kidneys, or liver; electrolyte imbalance; moderate to
severe anemia; postural ortostatic tachycardia syndrome (POTS); malignancies;
nutritional deficits; and medications
what kind of questions should you use to explore the attributes of the patient's
fatigue? - ANSWER:open-ended questions
encourage the patient to fully describe what he or she is experiencing
important clues about etiology often emerge from a good - ANSWER:psychosocial
history, exploration of sleep patterns, and a thorough review of systems
weakness - ANSWER:different from fatigue
it denotes a demonstrable loss of muscle power
weakness, especially if localized in a neuroanatomic pattern, suggests possible
neuropathy or myopathy
odors of the body and breath - ANSWER:odors can be important diagnostic clues,
such as the fruity odor of diabetes or the scent of alcohol
breath odors of alcohol, acetone (diabetes), pulmonary infections, uremia, or liver
failure
never assume that alcohol on a patient's breath explains changes in mental status or
neurologic findings
these changes may have serious but treatable causes such as hypoglycemia, subdural
hematoma, or postictal state
Examination and History Taking, 3rd Edition By Beth
Hogan-Quigley; Mary Louis Palm
the objective observation of the patient begins with - ANSWER:the first moments of
the encounter and continues throughout the history and physical examination
the nonverbal cues collected during the general survey enable the nurse to -
ANSWER:select appropriate subjective questions for the individual patient to garner
more information
many factors are assessed, such as - ANSWER:-the patient's general appearance
-apparent state of health
-demeanor
-facial expression or affect
-grooming
-posture
-gait
-height
-weight
many factors contribute to the patient's makeup: - ANSWER:-genetic composition
-early illnesses
-socioeconomic status
-culture
-gender identity and expression
-nutrition
-degree of fitness
-mood state
-geographic location
-age cohort
the patient's status affects many of the characteristics you assess, including -
ANSWER:-blood pressure
-posture
-mood and alertness
-facial coloration
-dentition
-condition of the tongue and gingiva
-color of the nail beds
-muscle bulk
general survey--initial observations - ANSWER:physical appearance and apparent
state of health and mood
-overall appearance and apparent age
,-level of consciousness
-facial features and expressions
-demeanor and affect
-posture
-gait
-motor activity
-speech
-skin color and lesions
-dress and personal hygiene
what do the vital signs include? - ANSWER:-blood pressure
-heart rate
-respiratory rate
-temperature
although pain is a subjective finding, in order to ensure frequent pain assessment,
especially in a hospital or rehabilitation setting, pain has been labeled the -
ANSWER:"fifth vital sign"
pain assessment is commonly missed, and when pain is noted, it is often -
ANSWER:not effectively managed
pain is a frequent motivator for people to seek health care
depending on the clinical setting, some might also consider oxygen saturation using a
pulse oximeter, blood glucose level, or the Glasgow Coma Scale as the fifth vital sign
apparent state of health - ANSWER:try to make a general judgment based on
observations throughout the encounter
support with significant details
does the patient look his or her age? appear ill? fatigued?
level of consciousness - ANSWER:is the patient awake, alert, and responsive to you
and others in the environment? if not promptly assess the level of consciousness
orientation can be checked by asking about person, place, time, and situation
facial expression - ANSWER:observe the facial expression at rest, during
conversation, during the physical examination, and in interaction with others
watch closely for eye contact
is it natural? sustained and unblinking? quickly averted? absent?
are the movements of the face symmetric? is there ptosis? an uneven smile?
posture, gait, motor activity, and speech - ANSWER:what is the patient's preferred
posture? assess the patient before calling his or her name in the waiting room. how
is the patient sitting? does the position or nonverbal communication change when
you are in the room with the patient? patients often prefer sitting upright in left-
sided heart failure and leaning forward with arms braced in chronic obstructive
pulmonary disease (COPD)
, is the patient restless or quiet? how often does the patient change position? how
fast/slow are the movements? anxious patients appear agitated and restless.
patients in pain often avoid movement
is there any apparent involuntary motor activity? are some body parts immobile?
which ones? look for tremors, other involuntary movements, or paralysis
does the patient walk smoothly, with comfort, self-confidence, and balance or is
there a limp or discomfort, fear of falling, loss of balance, or any movement
disorder? does the patient use an assistive device to ambulate? cane? walker?
brace?
is the patient's speech articulate? garbled? rapid or slow?
fatigue - ANSWER:a nonspecific symptom with many causes
it refers to a sense of weariness or loss of energy that patients describe in various
ways "i don't feel like getting up in the morning" "i don't have any energy" "i just feel
blah" "I'm all done in" "i can hardly get through the day" "by the time i get to the
office i feel as if i've done a day's work"
because fatigue is a normal response to hard work, sustained stress, or grief, try to
elicit the life circumstances in which it occurs
fatigue unrelated to such situations requires further investigation
fatigue is a common symptom of depression and anxiety states, but also consider
infections (such as hepatitis, infectious mononucleosis, and tuberculosis); endocrine
disorders (hypothyroidism, adrenal insufficiency, diabetes mellitus); heart failure;
chronic disease of the lungs, kidneys, or liver; electrolyte imbalance; moderate to
severe anemia; postural ortostatic tachycardia syndrome (POTS); malignancies;
nutritional deficits; and medications
what kind of questions should you use to explore the attributes of the patient's
fatigue? - ANSWER:open-ended questions
encourage the patient to fully describe what he or she is experiencing
important clues about etiology often emerge from a good - ANSWER:psychosocial
history, exploration of sleep patterns, and a thorough review of systems
weakness - ANSWER:different from fatigue
it denotes a demonstrable loss of muscle power
weakness, especially if localized in a neuroanatomic pattern, suggests possible
neuropathy or myopathy
odors of the body and breath - ANSWER:odors can be important diagnostic clues,
such as the fruity odor of diabetes or the scent of alcohol
breath odors of alcohol, acetone (diabetes), pulmonary infections, uremia, or liver
failure
never assume that alcohol on a patient's breath explains changes in mental status or
neurologic findings
these changes may have serious but treatable causes such as hypoglycemia, subdural
hematoma, or postictal state
