Seidel's Guide to Physical Examination 9th Edition Ball Test Bank

Seidel's Guide to Physical Examination 9t   Chapter 01: The History and Interviewing Process Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which question would be considered a “leading question?” a. “Please describe any associated symptoms with your headaches?” b. “You don't get headaches often, do you?” c. “What activities affect the severity of your headaches?” d. “What times of the day are your headaches the most severe?” e. “What worries you most about your headache?” ANS: B This question would limit the information in the patient's answer. The other choices allow the patient more discretion about the extent of an answer. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient's language? a. Ask a person unfamiliar with the patient to translate. b. Have a friend of the patient translate. c. Ask simple leading questions that the patient may understand. d. Use a neighbor as translator. e. Involve the family with the translation. ANS: A NURSINGTB.COM When you do not speak the patient's language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased. TOP: Discipline: Behavioral Science MSC: Organ System: General 3. Periods of silence during the interview can serve important purposes, such as: a. allowing the clinician to catch up on documentation. b. giving you a clue that you should speed up the interview. c. providing time for reflection. d. increasing the length of the visit. e. promoting a calm environment. ANS: C Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard. TOP: Discipline: Behavioral Science MSC: Organ System: General 4. Which technique is most likely to result in the patient's understanding of questions? a. Use phrases that are commonly used by other patients in the area. b. Use the patient's own terms if possible. c. Use language that keeps the patient from being expansive in his or her answer. d. Use proper medical and technical terminology. e. Use the simplest language possible. ANS: B To ensure that your questions have been correctly understood, be clear, and explicit while using the patient's idiom and level of understanding. TOP: Discipline: Behavioral Science MSC: Organ System: General 5. A patient becomes restless during the history and says, “I don't have time for all of this conversation. I've got to get back to work.” Your most appropriate response would be to: a. stop using open-ended questions and become more direct. b. ask another open-ended question and insist on an answer. c. ask questions about his anger and move closer to him. d. acknowledge his anger and proceed with the history and examination. e. ignore his displeasure and become more assertive about getting answers. ANS: D This is the only answer that resists the tendency for patient manipulation, pursues the information, and confronts the patient's anger. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. When questioning a patient regarding alcohol intake, she tells you that she is “only a social drinker.” Which initial response is appropriate? a. “I'm glad that you are a responsible drinker.” b. “Many people who are reNallyRalcIohoGlic sBay.tCheyMare social drinkers.” c. “What amount and what kind of alcohol do you drink in a week?” d. “If you only drink socially, you won't need to worry about always having a designated driver.” e. “Do the other people in your household consume alcohol?” ANS: C This answer clarifies the patient's own term without asking a leading question or being judgmental. TOP: Discipline: Behavioral Science MSC: Organ System: General 7. A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate? a. “Can you describe the pain?” b. “The pain doesn't radiate to your arm, does it?” c. “Have you been treated for anxiety before?” d. “Does your father have heart disease?” e. “Are the pains worse after you eat?” ANS: A Initially, an open-ended question is a more appropriate response. “Can you describe the pain?” is an open-ended question that offers clues to the chief concern. TOP: Discipline: Behavioral Science MSC: Organ System: General 8. Ms. A. states, “My life is just too painful. It isn't worth it.” She appears depressed. Which one of the following statements is the most appropriate caregiver response? a. “Try to think about the good things in life.” b. “You shouldn't feel that way; look at all the good things in your life.” c. “You can't mean what you're saying.” d. “If you think about it, nothing is worth getting this upset about.” e. “What in life is causing you such pain?” ANS: E Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance. TOP: Discipline: Behavioral Science MSC: Organ System: General 9. During an interview, you have the impression that a patient may be considering suicide. Which action is essential? a. Immediately begin proceedings for an involuntary commitment. b. Ask whether the patient has considered self-harm. c. Ask whether the patient would like to visit a psychiatrist. d. Record the impression in the patient's chart and refer the patient for hospitalization. e. Avoid directly confronting the patient regarding your impression. ANS: B If you think the patient may bNeUcRonSsiIdeNrGinTg BCidOe,Mhe or she probably is. Mentioning it gives permission to talk about it. TOP: Discipline: Behavioral Science MSC: Organ System: General 10. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should: a. never be interviewed alone because this may alienate the parent. b. be mailed a questionnaire in advance to avoid the need for her to talk. c. be given the opportunity to be interviewed without the parent at some point. d. be allowed to direct the flow of the interview. e. be ignored while you address all questions to the parent. ANS: C An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice. TOP: Discipline: Behavioral Science MSC: Organ System: General 11. When communicating with older children and teenagers, you should be sensitive to their: a. parent's needs. b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk. e. desire for adult companionship. ANS: D Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality. TOP: Discipline: Behavioral Science MSC: Organ System: General 12. When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should: a. order a neurology consult. b. stop all of his medications. c. continue to press the patient for appropriate answers. d. validate the concern with his family or caregivers. e. dismiss the finding as a normal age-related change. ANS: D When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps. TOP: Discipline: Behavioral Science MSC: Organ System: General 13. To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional? a. All information should be obtained from family members. b. All information should be collected from past records while the patient is in another room. c. The patient should be invNolveRd oInlyGwheBn.yCou sMense that he or she may feel ignored. d. The patient should be fully involved to the limit of his or her ability. e. The patient should be present during information collection but should not be addressed directly. ANS: D Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient. TOP: Discipline: Behavioral Science MSC: Organ System: General 14. When taking a history, you should: a. ask patients to give you any information they can recall about their health. b. start the interview with the patient's family history. c. use a chronologic and sequential framework. d. use a holistic and eclectic structure. e. start the interview with the social history. ANS: C To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient's family history and with the social history are incorrect because gathering data about the chief concern is the initial step. TOP: Discipline: Behavioral Science MSC: Organ System: General 15. When questioning the patient regarding his or her sexual history, which question should be asked initially? a. “Do you have any particular sexual likes or dislikes?” b. “Do you have any worries or concerns regarding your sex life?” c. “How often do you have intercourse and with whom?” d. “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” e. “What sexually transmitted diseases have you had in the past?” ANS: B When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient's feelings about the issue. TOP: Discipline: Behavioral Science MSC: Organ System: General 16. Direct questioning about intimate partner violence in the home should be: a. a routine component of history taking with female patients. b. avoided for fear of offending the woman's partner. c. conducted only in cases in which there is a history of abuse. d. used only when the patienNtUisRoSbvIioNuGslTy BCgOvMictimized. e. used only when bruises are found on physical examination. ANS: A The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients. TOP: Discipline: Behavioral Science MSC: Organ System: General 17. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: a. Miller Analogies Test. b. PACE Assessment Instrument. c. CAGE questionnaire. d. Glasgow Coma Scale. e. HITS questionnaire. ANS: C The CAGE questionnaire is a model for approaching a discussion of the use of alcohol. TOP: Discipline: Behavioral Science MSC: Organ System: General 18. When you enter the examination room of a 3-year-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to: a. screen the child for sexual abuse. b. ask the child to be seated on the examination table so you can talk to her father. c. explain to the child that you will not hurt her and that she will have to trust you. d. ask the father to persuade the child to cooperate with you. e. leave the child sitting in the father's lap while you talk to the father. ANS: E Interaction with children must be modified according to age and in a manner that promotes trust. TOP: Discipline: Behavioral Science MSC: Organ System: General 19. Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health? a. Attachment to parents b. Tendency to give too much information c. Low peer support needs d. Propensity for risk taking e. High self-esteem ANS: D Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information. TOP: Discipline: Behavioral Science MSC: Organ System: General 20. Pain is difficult to assess in older adults because: a. their histories are usuallyNunrReliaIble.G B.C M b. sharp pain may be felt as a dull ache. c. they tend to exaggerate symptoms. d. their language skills decline. e. drugs act more rapidly with age. ANS: B Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner from those in other age groups. TOP: Discipline: Behavioral Science MSC: Organ System: General 21. A survey of mobility and activities of daily living (ADL) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. e. sexual history. ANS: B A functional assessment is an assessment of a patient's mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living. TOP: Discipline: Behavioral Science MSC: Organ System: General 22. Constitutional symptoms in the ROS refer to: a. height, visual acuity, and body mass index. b. fever, chills, fatigue, and malaise. c. hearing loss, tinnitus, and diplopia. d. rashes, skin turgor, and temperature. e. joint stiffness, redness, and swelling. ANS: B General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change). TOP: Discipline: Behavioral Science MSC: Organ System: General 23. J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history. a. complete b. inventory c. problem or focused d. interim e. family ANS: C If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate. TOP: Discipline: Behavioral Science MSC: Organ System: General 24. A pedigree diagram is draftedNfoRr theIpuGrposBe.oCf obMtaining: a. sexual orientation and history. b. growth and developmental status. c. genetic and familial health problems. d. ethnic and cultural backgrounds. e. the past medical history. ANS: C Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems. TOP: Discipline: Behavioral Science MSC: Organ System: General Chapter 02: Cultural Competency Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which statement is true regarding the relationship of physical characteristics and culture? a. Physical characteristics should be used to identify members of cultural groups. b. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. c. To be a member of a specific culture, an individual must have certain identifiable physical characteristics. d. Gender and race are the two essential physical characteristics used to identify cultural groups. e. Whereas all cultural traits can be viewed as static, physical traits are dynamic. ANS: B Physical characteristics do not symbolize cultural groups; there is a difference between the two, and they are considered separately. Cultures are dynamic in their evolution. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. A fixed image of any group that rejects its potential for originality or individuality is known as a(n): a. acculturation. b. norm. c. stereotype. d. ethnos. e. custom. ANS: C NURSINGTB.COM This definition describes a stereotype. A norm, on the other hand, is a standard of allowable behavior within a group, ethnos implies the same race or nationality, and acculturation is a process of adopting another culture's behaviors. A custom refers to a habitual activity of a group in a given situation. TOP: Discipline: Behavioral Science MSC: Organ System: General 3. Your new patient is a 40-year-old Middle Eastern man with a complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to: a. do the examination because it is a necessary part of the physical examination. b. ask a colleague from the same geographic area if this examination is acceptable. c. inform the patient of the reason for the examination and ask if it is acceptable to him. d. refer the patient to a provider more knowledgeable about cultural differences. e. forego the examination for fear of violating cultural norms. ANS: C Asking, if you are not sure, is far better than making a damaging mistake. You would not be doing your job as a professional if you deferred the examination without a reason. It is not necessary to refer a skill you are capable of performing. TOP: Discipline: Behavioral Science MSC: Organ System: General 4. Which statement is true regarding impoverished people? a. In the United States, socioeconomic status does not influence the delivery of health care. b. The morbidity and mortality rates of impoverished people are greater than those of the middle class. c. The morbidity and mortality rates of impoverished people are less than those of the middle class. d. No reliable statistics exist regarding the relationship of poverty to morbidity and mortality. e. The morbidity and mortality rates of impoverished people are similar to those of the middle class. ANS: B Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity. TOP: Discipline: Behavioral Science MSC: Organ System: General 5. In terms of cultural communication differences, Americans are more likely to than other groups of patients. a. emphasize attitudes and feelings b. maintain eye contact NURSINGTB.COM c. come quickly to the point d. use silence comfortably e. speak more softly than other cultures ANS: C In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. Which question has the most potential for exploring a patient's cultural beliefs related to a health problem? a. “How often do you have a medical examination?” b. “What are your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” e. “Do you take herbal remedies?” ANS: D This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. TOP: Discipline: Behavioral Science MSC: Organ System: General 7. A person's definition of illness is likely to be most influenced by: a. race. b. ritual. c. enculturation. d. age group. e. socioeconomic class. ANS: C The definition of “ill” is determined in large part by the individualand the process whereby an individual assumes the traits and behaviors of a given culture. TOP: Discipline: Behavioral Science MSC: Organ System: General 8. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine's attempt to: a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. use herbal remedies and rituals. e. promote balance in an individual's life. ANS: B A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more “holistic” approach. TOP: Discipline: Behavioral SNciUenRceSINGMTSBC.: COrOgaMn System: General 9. A naturalistic or holistic approach to health care often assumes: a. that hot conditions require treatment with a hot remedy. b. a reductionist view that looks to a very narrow cause and effect. c. there are external factors that must be kept in balance. d. that there are hot and cold conditions but not hot and cold remedies. e. that hot and cold conditions are the same among different cultures. ANS: C A naturalistic or holistic approach often assumes that there are external factors—some good, some bad—that must be kept in balance if we are to remain well. TOP: Discipline: Behavioral Science MSC: Organ System: General 10. Which maternal factor is most predictive of whether an infant will receive inoculations? a. The mother has family support. b. The mother is divorced. c. The mother breast-feeds. d. The mother uses drugs. e. The mother received prenatal care. ANS: E Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well. TOP: Discipline: Behavioral Science MSC: Organ System: General 11. Knowledge of the culture(s) of the patient should be used to: a. form a standard practice procedure for that culture. b. draw conclusions regarding individual patient needs. c. form stereotypical categories. d. help make the interview questions more pertinent. e. form a sense of the patient based on prior knowledge. ANS: D The purpose of understanding the patient's culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. TOP: Discipline: Behavioral Science MSC: Organ System: General 12. The attitudes of the healthcare professional are largely: a. acculturated and cannot be changed. b. uninfluenced by patient behavior. c. difficult for the patient to sense. d. culturally derived. e. irrelevant to the success of relationships with the patient. ANS: D The attitude of a healthcare provider is foundationally derived from his or her own culture but cannot cause stereotypical judgments to be made; understanding this is relevant to the success of patient relationships. Attitudes of the healthcare professional are easily detected by others, and they influence patient beNhaUvRioSr. INGTB.COM TOP: Discipline: Behavioral Science MSC: Organ System: General 13. All of the following are important aspects of reducing disparities in health care except: a. identify and monitor conscious and unconscious biases. b. help the patient to learn about his or her disease or condition. c. consider the health literacy of one's patients. d. try to discuss aspects of care without the influence of friends, partner, or family members. e. encourage patients to complete patient satisfaction and demographics forms. ANS: D All of the above are ways a healthcare provider can reduce disparities in health care except the exclusion of a patient's friends, partner, or family members. It is important in reducing disparities in health care for the provider to partner with patients and families to provide high-quality care. TOP: Discipline: Behavioral Science MSC: Organ System: General 14. Which of the following is not an aspect of cultural humility? a. Ability to recognize one's limitations in knowledge and cultural perspective b. Self-reflection and self-critique c. Assuming all patients of a particular culture fit a certain stereotype d. Meeting patients “where they are” without judgment e. Genuine interest in understanding our patients' belief systems and lives ANS: C Rather than assuming all patients of a particular culture fit a certain stereotype, healthcare providers should view patients as individuals. In doing so, cultural humility helps equalize the imbalance in the patient-provider relationship. TOP: Discipline: Behavioral Science MSC: Organ System: General NURSINGTB.COM Chapter 03: Examination Techniques and Equipment Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing: a. suture removal. b. trachea care and suctioning. c. wet-to-dry dressing changes. d. patient bathing. e. tube feedings. ANS: B Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. TOP: Discipline: Pathophysiology MSC: Organ System: General 2. Standard Precautions apply to all patients: a. with bloodborne infections. b. with infected, draining wounds. c. in intensive care units. d. receiving care in hospitals or office settings. e. believed to have an infectious disease. ANS: D NURSINGTB.COM Although all of these statements are true, the best answer is patients receiving care in hospitals. Standard Precautions were developed with the intent of application to the care of all hospitalized or outpatients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered. TOP: Discipline: Pathophysiology MSC: Organ System: General 3. Which patient is at the highest risk for the development of latex allergy? a. A new patient who has no chronic illness and has never been hospitalized b. A patient who has had multiple procedures or surgeries c. A patient who is allergic to eggs d. A patient who is allergic to contrast dye e. A patient who is a vegetarian ANS: B A patient who has had multiple procedures or surgeries has a higher exposure rate to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. TOP: Discipline: Pathophysiology MSC: Organ System: General 4. Which patient position is useful for auscultating heart tones? a. Lithotomy b. Dorsal recumbent c. Left lateral recumbent d. Right Sims e. Prone ANS: C The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. TOP: Discipline: Pathophysiology MSC: Organ System: General 5. The use of secondary, tangential lighting is most helpful in the detection of: a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. e. variations in texture and mobility. ANS: D Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. TOP: Discipline: Pathophysiology MSC: Organ System: General 6. You are conducting a head to toe examination as part of a patient's preventive health assessment. The room has adequate lighting, and you have access to both sides of the examining table. What positiNon sRhouIld yGou BCmeMwhile conducting this examination? a. Behind the patient b. To the left side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient e. Standing in front of the patient ANS: D Although conventionally taught to approach an examination from the patient's right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. TOP: Discipline: Pathophysiology MSC: Organ System: General 7. Which part of the examiner's hand is best for palpating vibration? a. Dorsal surface b. The thumb c. Fingertips d. Ulnar surface and base of the fingers e. Finger pads ANS: D The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus. TOP: Discipline: Pathophysiology MSC: Organ System: General 8. The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder the percussion tone. b. The less dense the medium, the louder the percussion tone. c. The more hollow the area percussed, the quieter the percussion tone. d. Percussion over bony areas produces the loudest percussion tones. e. Percussion tones are produced by the structure immediately beneath the skin. ANS: B Percussion sounds vary according to the tissue being percussed. Whereas less dense tissue (e.g., over a normal lung) produces a loud tone, more dense tissue (e.g., a muscle) produces a softer tone. Percussion tones arise from vibrations 4 to 6 cm deep in the body tissue. TOP: Discipline: Pathophysiology MSC: Organ System: General 9. Expected normal percussion tones include: a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. e. resonance over the liver. ANS: C Whereas a normal lung produces resonance percussion tones, an empty stomach is expected to produce tympany. Dull percuNssUioRnStoInNesGaTreBCrdOoMver the liver. TOP: Discipline: Pathophysiology MSC: Organ System: General 10. When percussing, a dull tone is expected to be heard over: a. most of the abdomen. b. emphysemic lungs. c. the liver. d. healthy lung tissue. e. an empty stomach. ANS: C Dull tones are expected over more dense areas such as the liver. TOP: Discipline: Pathophysiology MSC: Organ System: General 11. During percussion, the downward snap of the striking fingers should originate from the: a. wrist. b. forearm. c. shoulder. d. interphalangeal joint. e. elbow. ANS: A The dominant hand's middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. TOP: Discipline: Pathophysiology MSC: Organ System: General 12. During auscultation, you can limit your perceptual field best by: a. asking patients to describe their symptoms. b. listening through the patient's clothing. c. closing your eyes. d. performing palpation before percussion. e. turning out the lights in the examination room. ANS: C By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds. TOP: Discipline: Pathophysiology MSC: Organ System: General 13. When examining the abdomen, which technique should be used first? a. Inspection b. Light palpation c. Percussion d. Auscultation e. Direct palpation ANS: A Inspection is always used as the first technique in all physical examinations, including the abdomen. NURSINGTB.COM TOP: Discipline: Pathophysiology MSC: Organ System: General 14. Auscultation should be carried out last except when examining: a. the neck area. b. the abdomen. c. the lungs. d. the heart. e. none of the above; auscultation is always carried out last in a proper physical examination. ANS: B Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. TOP: Discipline: Pathophysiology MSC: Organ System: General 15. Which of the following statements is true regarding tympanic membrane temperature? a. It is taken by placing an infrared probe anterior to the ear. b. The probe is placed in the external auditory canal to occlude it. c. Temperatures taken with a tympanic thermometer never vary from those taken by the oral or rectal route. d. It is an accurate measurement of body temperature because the tympanic membrane shares its blood supply with the hypothalamus. e. It is taken by placing an infrared probe posterior to the ear. ANS: D The tympanic membrane shares its blood supply with the hypothalamus and is therefore an accurate measurement of body temperature. Tympanic thermometer probes are gently placed at the external opening of the ear canal, but not in the canal, and they should not occlude the canal. TOP: Discipline: Pathophysiology MSC: Organ System: General 16. A scale used to assess a patient's weight should be calibrated: a. when the patient tells you the weight is not correct. b. by a qualified technician at regularly scheduled intervals. c. each time it is used. d. when necessary, with the patient standing on the scale. e. only by the manufacturer. ANS: C Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. TOP: Discipline: Pathophysiology MSC: Organ System: General 17. An infant should be placed in which position to have his or her height or length measured? a. Vertical, with the examiner's hands under the infant's axilla b. Supine on a measuring board c. While being held by a parent d. In the lateral position witNh thRe toIes aGgainBst.aCmeMasuring board e. Prone on a measuring board ANS: B An infant should be placed supine on a measuring board to measure height or length. TOP: Discipline: Pathophysiology MSC: Organ System: General 18. The stethoscope's diaphragm is most useful in the assessment of sounds. a. high-pitched b. dull c. low-pitched d. rhythmic e. tympanic ANS: A The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones. TOP: Discipline: Pathophysiology MSC: Organ System: General 19. Which of the following occurs when firm pressure is used to apply the stethoscope's bell endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece. c. Assessment findings are more accurate. d. Most sounds are occluded. e. Abnormally low sounds are better transmitted. ANS: B Applying firm pressure to the bell endpiece causes the skin to act as a diaphragm, obliterating the low-pitched sounds. TOP: Discipline: Pathophysiology MSC: Organ System: General 20. Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of stethoscope? a. Diaphragm end of an acoustic stethoscope b. Electronic c. Ultrasonic d. Magnetic e. Bell end of an acoustic stethoscope ANS: C Only the ultrasonic stethoscope, the Doppler, can detect blood flow rather than amplify sounds, which is needed in assessing weak pulses, fetal heart activity, and vessel patency. TOP: Discipline: Pathophysiology MSC: Organ System: General 21. A patient in the emergency department has a concussion to the head. You suspect that the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient? a. StrabismoScope b. Red-free filter c. Slit lamp d. Small aperture e. Grid ANS: B NURSINGTB.COM The red-free filter permits recognition of hemorrhages. The grid estimates the size of lesions, the slit lamp examines the anterior eye and assesses the elevation of lesions, and the small aperture is used with small pupils. The strabismoScope is used for detecting strabismus. TOP: Discipline: Pathophysiology MSC: Organ System: General 22. Which type of speculum should be used to examine a patient's tympanic membrane? a. The smallest speculum that will illuminate the ear b. The largest speculum that will fit comfortably in the ear c. The shortest speculum available d. Any speculum that will fit the otoscope head e. The longest speculum available ANS: B To visualize the tympanic membrane adequately, the largest speculum that can comfortably fit in the car canal should be used. The other choices do not ensure greater visibility of the membrane and landmarks. TOP: Discipline: Pathophysiology MSC: Organ System: General 23. The pneumatic attachment for the otoscope is used to evaluate: a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. e. tympanic membrane temperature. ANS: D The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement. TOP: Discipline: Pathophysiology MSC: Organ System: General 24. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: a. vibratory sensations. b. hearing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level. e. peripheral motor nerve damage. ANS: C Normal speech has a range of 300 to 3000 Hz; therefore, a 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech. TOP: Discipline: PathophysiolNogyR I GMSBC:.COrgaMn System: General U S N T O 25. A variant of the percussion hammer is a neurologic hammer, which is equipped with which of the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell e. Transilluminator ANS: A A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached. TOP: Discipline: Pathophysiology MSC: Organ System: General 26. Transillumination functions on the principle that: a. infrared radiation is easily detected. b. black light causes certain substances to fluoresce. c. converging and diverging light brings structures into focus. d. tangential light casts shadows that illuminate contours. e. air, fluid, and tissue transmit light differentially. ANS: E Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. It consists of a strong light in the visible spectrum with a narrow beam. TOP: Discipline: Pathophysiology MSC: Organ System: General 27. For a woman with a small vaginal opening, the examiner should use a _ speculum. a. plastic Graves b. Pederson c. pediatric d. nasal e. metal Graves ANS: B The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrower and flatter and are therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic speculums are similar in use to their metal counterparts. TOP: Discipline: Pathophysiology MSC: Organ System: General 28. You are performing a vaginal examination on a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation? a. Replace the metal speculum with a plastic one. b. Put a blanket over the patient's legs. c. Remove the speculum. d. Take her blood pressure. NURSINGTB.COM e. Raise her legs above her heart. ANS: C This patient is experiencing symptoms of autonomic hyperreflexia. The first reaction should be for the examiner to remove the source of the stimulation. Cold tables, stirrups, insertion of a speculum, and pressure during pelvic examinations are examples of stimulations. TOP: Discipline: Pathophysiology MSC: Organ System: General Chapter 04: Clinical Reasoning Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. After the subjective and objective data have been prioritized, the next step is to: a. order laboratory tests. b. formulate a problem list. c. establish the diagnosis. d. initiate therapy. e. initiate appropriate consultations. ANS: B Formulate a problem list problems as specifically as possible. Identify and list the signs and symptoms associated with each of patient's concerns as well as abnormalities discovered during the physical examination. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. New symptoms or findings of unknown etiology are: a. problems to be noted on the problem list. b. deferred for subsequent visits. c. diagnosed before physical examination. d. reserved for specialists. e. usually “red herrings.” ANS: A NURSINGTB.COM New findings of unknown causes are added to the problem list, but do not let them become a “red herring” that distracts your attention from the central issues. TOP: Discipline: Behavioral Science MSC: Organ System: General 3. Which of the following is an accepted method of making a diagnosis? a. Always unifying your findings into one diagnosis b. Making maximal use of laboratory tests c. Using first assumptions d. Using algorithms e. Relying on intuition ANS: D Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Unifying all of your findings into one diagnosis is not always possible. More than one disease process can exist at one time in the same patient. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions. TOP: Discipline: Behavioral Science MSC: Organ System: General 4. Medical decision making requires a balance between: a. speculation and feelings. b. opinions and beliefs. c. knowledge and superstition. d. Mechanism and probability. e. trust and suspicion. ANS: D Medical decision making must have a balance between mechanism and probability (certainty in knowledge is impossible). TOP: Discipline: Behavioral Science MSC: Organ System: General 5. When evaluating results of laboratory tests, a test that is highly sensitive implies that the test: a. suggests that a disease is present when it actually is not. b. will not have any false-positive results. c. suggests that a disease is absent when it is absent. d. is able to correctly identify for the disease being tested. e. is able to confirm a diagnosis even when the disease is not present. ANS: D Testing that is sensitive is a test that will be able to correctly identify persons with the disease that the test has been designed to test for. Positive results are more likely to be positive for the disease. High specificity suggests the ability of an observation to identify correctly those who do not have the disease. TOP: Discipline: Biostatistics MSC: Organ System: General 6. A specific test is one that has the ability to: a. correctly identify those who have the disease. b. correctly identify those wNho Rdo nIot hGaveBth.eCdisMease. c. be exclusively used to make a diagnosis. d. suggest the presence of a disease that is not present. e. exclude competing explanations for another test finding. ANS: B The specificity of a test is determined by its ability to identify those who do not have the disease that the test is designed to test for. Negative results are more likely to be valid. TOP: Discipline: Biostatistics MSC: Organ System: General 7. The proportion of persons with an observation characteristic of a disease that have the disease is known as value. a. sensitivity positive specific b. negative specific c. positive predictive d. negative predictive e. true negative ANS: C A positive predictive value is defined as the proportion of persons thought to have a disease who actually have the disease. TOP: Discipline: Biostatistics MSC: Organ System: General 8. Which of the following is not a component of a management plan? a. Presumptive diagnosis b. Subspecialty consultation c. Diet modification d. Follow-up visit e. Patient education ANS: A The management plan details what you are going to do about a patient problem such as subspecialty consultations, diet modifications, follow-up visits, and any necessary patient education. TOP: Discipline: Behavioral Science MSC: Organ System: General 9. When determining priorities for planned actions, the practitioner should: a. address problems in the order of their chronologic development. b. consider whether the patient is concerned about a particular problem before addressing it. c. ignore the patient's social and economic circumstances. d. address the most urgent problem first. e. never consider if the cost of care will impact other areas of the patient's life. ANS: D In developing patient care plans, priority should be given to the most life threatening and urgent physical needs of the patient. Then focus on addressing the patient's social and economic circumstances and whether the cost of care will impact other areas of the patient's life. NURSINGTB.COM TOP: Discipline: Behavioral Science MSC: Organ System: General 10. Bits of information that are distracting and draw your thinking away from central issues are referred to as: a. Bayes theorem. b. true negatives. c. mechanism and probability d. red herrings. e. false negatives. ANS: D Beware of red herrings, the bits of information that are distracting and draw your thinking away from central issues. Critically evaluate unexpected or unusual findings but do not let them distort full consideration of all you have learned. TOP: Discipline: Behavioral Science MSC: Organ System: General 11. In issues surrounding ethical decision making, beneficence refers to the: a. appropriate use of medical resources. b. care provider acting as a father or mother figure. c. care provider knowing what is best for the patient. d. need to avoid harming the patient. e. need to do good for the patient. ANS: E The definition of beneficence is to do good, not being paternalistic, and the need to avoid harm refers to nonmaleficence. Utilitarianism is the appropriate use of resources for the greater good of the larger community. TOP: Discipline: Behavioral Science MSC: Organ System: General 12. The term denoting the caregiver's need to do no harm to the patient is: a. autonomy. b. deontologic imperative. c. nonmaleficence. d. utilitarianism. e. beneficence. ANS: C The definition of nonmaleficence is to do no harm. TOP: Discipline: Behavioral Science MSC: Organ System: General 13. Which of the following is initially appropriate in the management of a patient's diagnosed problem? a. Inform the patient of the treatment plan. b. Give the patient detailed written instructions regarding the treatment plan. c. Inform the patient that the plan has been tailored to his needs. d. Inform the patient of treatment options and possible results. e. Lead the patient to an understanding that you know the best treatment option. ANS: D NURSINGTB.COM An initial approach to a patient's problem should allow for the greatest patient autonomy and should promote patient participation. The well-informed patient is better able to exercise autonomy. Only informing the patient of treatment options and possible results does this. TOP: Discipline: Behavioral Science MSC: Organ System: General Chapter 05: Documentation Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. During the course of the interview, you should: a. take no notes of any kind. b. take brief written notes. c. take detailed written notes. d. repeat pertinent comments into a Dictaphone. e. interrupt the interview to formulate your thoughts. ANS: B During the interviewing process, it is important to maintain eye contact with the patient and to spend as little time as possible looking at your notes, so brief written notes are more practical. Later you can go back and formulate a well-versed history by linking all the pieces together. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. Subjective and symptomatic data are: a. documented in your assessment. b. not mentioned in the legal chart. c. placed in the history sections. d. recorded with the examination technique. e. documented with the findings. ANS: C NURSINGTB.COM Subjective data, as well as symptomatic data, should not be part of the physical examination findings; rather, their documentation is appropriate for the history portion. TOP: Discipline: Behavioral Science MSC: Organ System: General 3. The quality of a symptom, such as pain, is subjective information that should be: a. deferred until the cause is determined. b. described in the history using a 0 to 10 scale. c. placed in the past medical history section. d. placed in the history with objective data. e. interpreted in light of your physical findings. ANS: B Pain is subjective, and only the patient can rate the perceived severity. Pain, therefore, should be recorded in the history using a 0 to 10 scale. TOP: Discipline: Behavioral Science MSC: Organ System: General 4. Drawing of stick figures is most useful to: a. compare findings in the extremities. b. demonstrate radiation of pain. c. indicate organ enlargement. d. indicate mobility of masses. e. indicate consistency of lymph nodes. ANS: A Simple drawings, such as stick figures, are more practical illustrations for findings in the extremities. Radiation of pain, organ enlargement, consistency of lymph nodes, and mobility of masses would not be adequately described by such simple drawings. TOP: Discipline: Behavioral Science MSC: Organ System: General 5. Which of the following is an example of a problem requiring recording on the patient's problem list? a. Common age variations b. Expected findings c. Findings of unknown origin d. Minor variations e. Only findings that have a clear etiology ANS: C Any problem is worth noting on the patient problem list even if the etiology or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as problems. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. d. plan. e. laboratory data. ANS: C NURSINGTB.COM Differential diagnoses for problems that have not been diagnosed are placed in the assessment category for each problem. The differentials are prioritized, and contributing factors are identified. TOP: Discipline: Behavioral Science MSC: Organ System: General 7. When recording assessments during the construction of the problem-oriented medical record, the examiner should: a. combine all data into one assessment. b. create an assessment for each problem on the problem list. c. create an assessment for every abnormal physical finding. d. create an assessment for every symptom presented in the history. e. create an assessment for each abnormal laboratory finding. ANS: B After the examiner has a list of problems constructed, an assessment is made for each unique problem. TOP: Discipline: Behavioral Science MSC: Organ System: General 8. Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical examination. This visit would be documented by creating a(n): a. progress note. b. incident report. c. problem-oriented medical record. d. triage note. e. new problem list. ANS: A A second visit with the clinician is always recorded on a progress note, noting any updates to the condition. TOP: Discipline: Behavioral Science MSC: Organ System: General 9. The effect of the chief concern on the patient's lifestyle is recorded in which section of the medical record? a. Chief complaint b. History of present illness c. Past medical history d. General patient information e. Social history ANS: B The effect of the patient's complaint on his or her current everyday lifestyle or work performance is recorded in the history of present illness. TOP: Discipline: Behavioral SNciUenRceSINGMTSBC.: COrOgaMn System: General 10. The patient's perceived disabilities and functional limitations are recorded in the: a. problem list. b. general patient information. c. social history. d. review of systems. e. past medical history. ANS: E Past medical history contains information about the patient's lifetime as well as disabilities or functional limitations that alter activities of daily living. TOP: Discipline: Behavioral Science MSC: Organ System: General 11. The review of systems is a component of the: a. physical examination. b. health history. c. assessment. d. past medical and surgical history. e. personal and social history. ANS: E Review of systems relates health history according to physical systems and is related just before the actual physical examination. TOP: Discipline: Behavioral Science MSC: Organ System: General 12. Allergies to drugs and foods are generally listed in which section of the medical record? a. General patient information b. Past medical history c. Social history d. Problem list e. History of present illness ANS: B The past medical history section contains information such as drugs, foods, and environmental allergies. TOP: Discipline: Behavioral Science MSC: Organ System: General 13. Objective data are usually recorded: a. by body systems. b. in the history. c. subsequent to the assessment and plan. d. before the health history. e. in the problem list. ANS: A All objective data are recorded by body systems and anatomic locations. 14. 14. TOP: Discipline: Behavioral Science MSC: Organ System: General N R I G B.C M Information recorded about an infant differs from that of an adult, mainly because of the infant's: a. attention span. b. developmental status. c. nutritional differences. d. source of information. e. limited past medical history. ANS: B The organizational structure of an infant's record is different because the infant's current and future health is referenced in terms of developmental status. TOP: Discipline: Behavioral Science MSC: Organ System: General 15. In which section of the newborn history would you find details of gestational assessment and extrauterine adjustment data? a. Family b. General patient information c. Personal and social d. Present problem e. Past medical ANS: D For a newborn, the focus of recorded information is the details of the mother's pregnancy, the gestational development, and events occurring since birth. These data are recorded in the present problem section of the history. TOP: Discipline: Behavioral Science MSC: Organ System: General 16. Data relevant to the social history of older adults include information on: a. family support systems. b. extra time to assume positions. c. over-the-counter medication intake. d. date of last cancer screening. e. previous healthcare visits. ANS: A The social history of older adults includes community and family support systems. Healthcare visits, medications, cancer screenings, and extra time to assume positions for the physical examination are not part of the social history. TOP: Discipline: Behavioral Science MSC: Organ System: General 17. A SOAP note is used in which type of recording system? a. Preventive care b. Pedigree c. Systems review d. Traditional treatment e. Problem oriented ANS: E NURSINGTB.COM A SOAP note, which includes subjective problem data, objective problem data, assessment, and plan, is a type of recording system that has a problem-oriented style. TOP: Discipline: Behavioral Science MSC: Organ System: General 18. The examiner's evaluation of a patient's mental status belongs in the: a. history of present illness. b. review of systems. c. physical examination. d. patient education. e. problem list. ANS: C Mental status assessment, including cognitive and emotional stability and speech and language, is part of the physical examination. Anything subjective is part of the review of systems and those findings that are objective are part of the provider's assessment. TOP: Discipline: Behavioral Science MSC: Organ System: General 19. When recording physical findings, which data are recorded first for all systems? a. Review of systems b. Percussion c. Palpation d. Auscultation e. Inspection ANS: E Physical assessment for all systems begins with inspection. TOP: Discipline: Behavioral Science MSC: Organ System: General 20. Regarding another provider's documented work, it: a. is not relevant in a legal proceeding. b. will not affect clinical decisions. c. may be copied verbatim into your documentation. d. must be attributed to the source if entered. e. does not affect patient care. ANS: D It is unacceptable to copy other providers' documented work (e.g., history taken, examination performed, or thought processes outlined) and enter it into your own documentation as if you did the work. Text copied from another person's note must always be attributed to the source. This is not only an important concept in a legal proceeding, but it is also critical for safe patient care. TOP: Discipline: Behavioral Science MSC: Organ System: General 21. Which of the following abbreviations is approved by The Joint Commission on Accreditation of Hospitals? a. U (unit) b. qd (daily) c. MS (morphine sulfate) d. All of the above e. None of the above ANS: B NURSINGTB.COM The Joint Commission has identified “improving communications among caregivers” as a patient safety goal. Certain abbreviations have been placed on a “do not use” list when an error in misreading the abbreviation could cause harm. All of the above abbreviations are on the “do not use” list. TOP: Discipline: Behavioral Science MSC: Organ System: General Chapter 06: Vital Signs and Pain Assessment Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Body temperature is regulated by the: a. thalamus. b. hypothalamus. c. medulla. d. pons. e. cerebellum. ANS: B Body temperature is regulated by the hypothalamus. TOP: Discipline: Pathophysiology MSC: Organ System: General 2. Which of the following is not involved in increasing body temperature? a. Exogenous pyrogens b. Vasoconstriction c. Shivering d. Vasodilation e. Prostaglandins ANS: D Body cooling occurs by vasodilation, which increases heat loss through the skin and evaporation of perspiration. NURSINGTB.COM TOP: Discipline: Pathophysiology MSC: Organ System: General 3. Which of the following is most closely related to damage or dysfunction of the central or peripheral nervous system? a. Chronic pain b. Neuropathic pain c. Acute pain d. Acute inflammation e. Surgery ANS: B Neuropathic pain is a long-term pain associated with damage or dysfunction of the central or peripheral nervous system (e.g., amputation, complex pain syndrome). TOP: Discipline: Pathophysiology MSC: Organ System: General 4. Nociceptors transmit pain impulses from the periphery along A-delta and C-polymodal fibers to the: a. posterior horn of the spinal cord. b. hypothalamus. c. cerebellum. d. dorsal horn of the spinal cord. e. pons. ANS: D Pain impulses travel from the site of injury to the dorsal horn of the spinal cord and then through the ascending spinal tracts to the thalamus and cerebral cortex. TOP: Discipline: Pathophysiology MSC: Organ System: General 5. Which of the following make infants more susceptible to hypothermia? a. Low body surface area for weight b. Thicker skin c. Limited ability to cope with cold stress d. Higher pulse rate e. Lower blood pressure ANS: C Infants are more susceptible to hypothermia because of their large ratio of body surface area to weight, thinner skin, and limited ability to cope with cold stress. Infants have a higher pulse rate and lower blood pressure than adults, but this is unrelated to hypothermia. TOP: Discipline: Pathophysiology MSC: Organ System: General 6. A 5-year-old is complaining of nondescriptive “belly pain.” Your next action should be to ask him to: a. point a finger to the spot that hurts. b. draw a circle around the area that hurts. c. use a metaphor to describe the pain. d. identify what makes the pNainRwoIrse.G B.C M e. allow him to use a “pain-o-meter.” ANS: A Asking the child to point to the area of pain can help communicate a more precise location. The other choices are not appropriate for the age of the child. TOP: Discipline: Behavioral Science MSC: Organ System: General 7. During pregnancy, all of the following may be related to back pain except: a. lax pelvic ligaments. b. weight gain. c. hyperlordosis. d. anterior tilt of the pelvis. e. lower blood pressure. ANS: E Blood pressure commonly decreases beginning at about 8 weeks of gestation, gradually falling until a low point is reached at midpregnancy, but this is unrelated to the back pain some women experience during pregnancy. TOP: Discipline: Pathophysiology MSC: Organ System: General 8. The value of the use of scales for patients to rate their pain intensity is that: a. the emotional responses are factored in. b. correlation with others’ expectations is achieved. c. the patient’s response to therapy can be documented. d. subjective responses are eliminated. e. the patient’s perception is minimized. ANS: C The use of scales permits the very important day-to-day documentation of the response to therapy. Although the patient’s perception is the controlling variable, the patient is still giving a subjective measurable response. TOP: Discipline: Behavioral Science MSC: Organ System: General 9. A pain scale that is reliable and valid for children is the: a. pain-o-meter scale. b. pain-rating instrument scale. c. numeric pain intensity scale. d. Wong/Baker Faces Rating Scale. e. descriptive pain intensity scale. ANS: D The Wong/Baker Faces Rating Scale and the Oucher Scale are examples of pain scales that are reliable and valid for use with children. TOP: Discipline: Behavioral Science MSC: Organ System: General 10. Which is the most reliable indicator of a patient’s pain? a. Facial grimacing b. Grunting or groaning c. Body movements d. Reluctance to be moved NURSINGTB.COM e. Patient’s report of the pain ANS: E The patient’s report of pain is the most reliable indicator of pain and should be believed even when observed behaviors do not seem to correspond. TOP: Discipline: Pathophysiology MSC: Organ System: General 11. Which of the following groups has the greatest variation in pulse rate? a. Toddlers b. Premature infants c. Neonates d. Adolescents e. Older adults ANS: B The newborn’s pulse rate is more variable than that of toddlers, adolescents, and older adults. The variation is greatest around the time of birth and is even more marked in premature infants. TOP: Discipline: Pathophysiology MSC: Organ System: General 12. The heart rate of a pregnant woman may increase to a level at term that is _ higher than normal. a. 5% to 10% b. 10% to 30% c. 40% to 60% d. 60% to 80% e. 80% to 100% ANS: B The heart rate of a pregnant woman gradually increases throughout pregnancy until it is 10% to 30% higher at term. TOP: Discipline: Pathophysiology MSC: Organ System: General 13. Hypertension in a pregnant woman (blood pressure reading greater than or equal to 160 mm Hg systolic or 110 mm Hg diastolic) is one sign of: a. a normal pregnancy. b. a nulliparous woman. c. preeclampsia. d. a multiparous woman. e. Braxton Hicks contractions. ANS: C A gradual increase in blood pressure is common from the second to the third trimester. However, hypertension in this range may be a sign of preeclampsia. Braxton Hicks contractions are sporadic uterine contractions that start at around 6 weeks of pregnancy and are not associated with gestational hypertension or preeclampsia. NURSINGTB.COM TOP: Discipline: Pathophysiology MSC: Organ System: General 14. Blood pressure may increase during the process of aging caused by: a. increasing vagal tone. b. decreasing cardiac output. c. diminished tolerance to pain. d. increasing stiffness of the blood vessels. e. decreasing vascular resistance. ANS: D During the process of aging the systolic blood pressure often increases because of increasing stiffness of the blood vessels and increased vascular resistance. Increasing vagal tone may decrease the pulse rate. TOP: Discipline: Pathophysiology MSC: Organ