Physical Assessment Ch. 13 Jarvis Test Bank Questions
with all Correct & 100% Verified Answers |Latest
Version |Already Graded A+
A physician tells the nurse that a patients vertebra prominens is tender and asks the nurse to
reevaluate the area in 1 hour. The area of the body the nurse will assess is:
A. just above the diaphgram
B. just lateral to the knee cap
C. at the level of C7 vertebra
D. at the level of the T11 vertebra ✔Correct Answer-C. at the level of C7 vertebra
The C7 vertebra has a long spinous process, called the vertebra prominens, which is palpable when
the head is flexed
A mother brings in her 2 month old daughter in for an examination and says, my daughter rolled over
against the wall, and now I have noticed that she has this spot that is soft on the top of her head. Is
something terribly wrong? The nurses best response would be:
A. Perhaps that could be the result of your dietary intake during pregnancy
B. Your baby may have craniosynostosis, a disease of the sutures of the brain
C. The soft spot may be an indication of cretinism or congenital hypothyroidism
D. The soft spot is normal, and actually allows for growth of the brain during the first year of your
baby's life. ✔Correct Answer-D. The soft spot is normal, and actually allows for growth of the brain
during the first year of your baby's life.
The nurse notices that a patients palpebral fissures are not symmetric. On examination, the nurse
may find that damage has occurs with which CN?
A. III
B. V
C. VII
D. VIII ✔Correct Answer-C. VII
Facial muscles are mediated by CN VII; asymmetry of palpebral fissure may be attributable to
damage to CN VII (Bell palsy)
A patient is unable to differentiate sharp and dull stimulation on both sides of her face. The nurse
suspects:
A. Bell palsy
B. damage to trigeminal nerve
C. frostbite with resultant paresthesia to the cheeks
D. scleroderma ✔Correct Answer-B. damage to trigeminal nerve
Facial sensations of pain or touch or mediated by CN V, which is the trigeminal nerve.
When examining the face of a patient, the nurse is aware that the two pairs of salivary glands are
accessible to examination are the ____ & ____ glands.
A. occipital; submental
B. parotid; jugulodigastric
C. parotid; submandibular
, D. submandibular; occipital ✔Correct Answer-C. parotid; submandibular
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head.
The nurse suspects damage to CN ___ and proceeds with the examination by ________.
A. XI; palpating the anterior and posterior triangles
B. XI; asking the patient to shrug her shoulders against resistance
C. XII; percussing the sternocleidomastoid and submandibular neck muscles
D. XII; assessing for positive Romberg sign ✔Correct Answer-B. XI; asking the patient to shrug her
shoulders against resistance
the major neck muscles are sternomastoid and trapezius. they are innervated by CN XI, spinal
accessory. the innervated muscles assist with head rotation and head flexion, movement of the
shoulders, and extension and turning of the head
When examining the patents CN function, the nurse remembers that the muscles in the neck are
innervated by CN XI are the:
A. sternomastoid and trapezius
B. spinal accessory and omohyoid
C. trapezius and sternomandibular
D. sternomandibular and spinal accessory ✔Correct Answer-A. sternomastoid and trapezius
A patients lab data reveals an elevated thyroxine (T4) level. The nurse would proceed with an
examination of the ____ gland.
A. thyroid
B. parotid
C. adrenal
D. parathyroid ✔Correct Answer-A. thyroid
thyroid gland secretes T3 and T4.
A patient says that she has recently noticed a lump in the front of her neck below her adams apple
that seems to be getting bigger. During the assessment, the finding that leads the nurse to suspect
that this may not be a cancerous thyroid nodule is that the lump (nodule):
A. is tender
B. is mobile and not hard
C. disappears when the patient smiles
D. is hard and fixed to the surrounding structures ✔Correct Answer-B. is mobile and not hard
painles, rapidly growing nodules may be cancerous, especially the appearance of single nodule in a
young person. However, cancerous nodules tend to be hard and fixed to surrounding structures, not
mobile
The nurse notices that a patients submental lymph nodes are enlarged. In an effort to identify the
cause of the node enlargement, the nurse would assess the patients:
A. infraclavicular area
B. supraclavicular area
C. area distal to the enlarged node
D. area proximal to the enlarged node ✔Correct Answer-D. area proximal to the enlarged node
when nodes are abnormal, the nurse should check the area into which they drain for the source of
the problem. The area proximal (upstream) to the location of the abnormal node should be explored.
with all Correct & 100% Verified Answers |Latest
Version |Already Graded A+
A physician tells the nurse that a patients vertebra prominens is tender and asks the nurse to
reevaluate the area in 1 hour. The area of the body the nurse will assess is:
A. just above the diaphgram
B. just lateral to the knee cap
C. at the level of C7 vertebra
D. at the level of the T11 vertebra ✔Correct Answer-C. at the level of C7 vertebra
The C7 vertebra has a long spinous process, called the vertebra prominens, which is palpable when
the head is flexed
A mother brings in her 2 month old daughter in for an examination and says, my daughter rolled over
against the wall, and now I have noticed that she has this spot that is soft on the top of her head. Is
something terribly wrong? The nurses best response would be:
A. Perhaps that could be the result of your dietary intake during pregnancy
B. Your baby may have craniosynostosis, a disease of the sutures of the brain
C. The soft spot may be an indication of cretinism or congenital hypothyroidism
D. The soft spot is normal, and actually allows for growth of the brain during the first year of your
baby's life. ✔Correct Answer-D. The soft spot is normal, and actually allows for growth of the brain
during the first year of your baby's life.
The nurse notices that a patients palpebral fissures are not symmetric. On examination, the nurse
may find that damage has occurs with which CN?
A. III
B. V
C. VII
D. VIII ✔Correct Answer-C. VII
Facial muscles are mediated by CN VII; asymmetry of palpebral fissure may be attributable to
damage to CN VII (Bell palsy)
A patient is unable to differentiate sharp and dull stimulation on both sides of her face. The nurse
suspects:
A. Bell palsy
B. damage to trigeminal nerve
C. frostbite with resultant paresthesia to the cheeks
D. scleroderma ✔Correct Answer-B. damage to trigeminal nerve
Facial sensations of pain or touch or mediated by CN V, which is the trigeminal nerve.
When examining the face of a patient, the nurse is aware that the two pairs of salivary glands are
accessible to examination are the ____ & ____ glands.
A. occipital; submental
B. parotid; jugulodigastric
C. parotid; submandibular
, D. submandibular; occipital ✔Correct Answer-C. parotid; submandibular
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head.
The nurse suspects damage to CN ___ and proceeds with the examination by ________.
A. XI; palpating the anterior and posterior triangles
B. XI; asking the patient to shrug her shoulders against resistance
C. XII; percussing the sternocleidomastoid and submandibular neck muscles
D. XII; assessing for positive Romberg sign ✔Correct Answer-B. XI; asking the patient to shrug her
shoulders against resistance
the major neck muscles are sternomastoid and trapezius. they are innervated by CN XI, spinal
accessory. the innervated muscles assist with head rotation and head flexion, movement of the
shoulders, and extension and turning of the head
When examining the patents CN function, the nurse remembers that the muscles in the neck are
innervated by CN XI are the:
A. sternomastoid and trapezius
B. spinal accessory and omohyoid
C. trapezius and sternomandibular
D. sternomandibular and spinal accessory ✔Correct Answer-A. sternomastoid and trapezius
A patients lab data reveals an elevated thyroxine (T4) level. The nurse would proceed with an
examination of the ____ gland.
A. thyroid
B. parotid
C. adrenal
D. parathyroid ✔Correct Answer-A. thyroid
thyroid gland secretes T3 and T4.
A patient says that she has recently noticed a lump in the front of her neck below her adams apple
that seems to be getting bigger. During the assessment, the finding that leads the nurse to suspect
that this may not be a cancerous thyroid nodule is that the lump (nodule):
A. is tender
B. is mobile and not hard
C. disappears when the patient smiles
D. is hard and fixed to the surrounding structures ✔Correct Answer-B. is mobile and not hard
painles, rapidly growing nodules may be cancerous, especially the appearance of single nodule in a
young person. However, cancerous nodules tend to be hard and fixed to surrounding structures, not
mobile
The nurse notices that a patients submental lymph nodes are enlarged. In an effort to identify the
cause of the node enlargement, the nurse would assess the patients:
A. infraclavicular area
B. supraclavicular area
C. area distal to the enlarged node
D. area proximal to the enlarged node ✔Correct Answer-D. area proximal to the enlarged node
when nodes are abnormal, the nurse should check the area into which they drain for the source of
the problem. The area proximal (upstream) to the location of the abnormal node should be explored.
