TEST BANK FOR Evidence-Based Physical
Examination for Health & Well-Being Assessment
2nd Edition
A semiconscious woman is brought to the emergency department after she was found
on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright
cherryred color. The nurse suspects that this coloring is due to: a.
Polycythemia.
b.
Carbon monoxide poisoning.
c.
Carotenemia.
d. Uremia.
-b
A patient has been admitted to a hospital after the staff in the nursing home noticed a
pressure ulcer in his sacral area. The nurse examines the pressure ulcer and
determines that it is a stage II ulcer. Which of these findings are characteristic of a
stage II pressure ulcer? Select all that apply. a.
Intact skin appears red but is not broken. b.
Partial thickness skin erosion is observed with a loss of epidermis or dermis. c.
Ulcer extends into the subcutaneous tissue. d.
Localized redness in light skin will blanch with fingertip pressure. e.
Open blister areas have a red-pink wound bed.
f.
Patches of eschar cover parts of the wound. - b, e
Which statement about the apices of the lungs is true? The apices of the lungs: a.
Are at the level of the second rib anteriorly. b.
Extend 3 to 4 cm above the inner third of the clavicles. c.
Are located at the sixth rib anteriorly and the eighth rib laterally. d.
Rest on the diaphragm at the fifth intercostal space in the midclavicular line (MCL). - b
When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft
breath sounds are heard over the posterior lower lobes, with inspiration being longer
than expiration. The nurse interprets that these sounds are: a.
Normally auscultated over the trachea. b.
Bronchial breath sounds and normal in that location. c.
,Vesicular breath sounds and normal in that location. d.
Bronchovesicular breath sounds and normal in that location - c
When inspecting the anterior chest of an adult, the nurse should include which
assessment?
a.
Diaphragmatic excursion
b.
Symmetric chest expansion
c.
Presence of breath sounds
d.
Shape and configuration of the chest wall - d
A man has come in to the clinic for a skin assessment because he is worried he might
have skin cancer. During the skin assessment the nurse notices several areas of
pigmentation that look greasy, dark, and stuck on his skin. Which is the best prediction?
a.
Senile lentigines, which do not become cancerous b.
Actinic keratoses, which are precursors to basal cell carcinoma c.
Acrochordons, which are precursors to squamous cell carcinoma d.
Seborrheic keratoses, which do not become cancerous - d
The nurse just noted from the medical record that the patient has a lesion that is
confluent in nature. On examination, the nurse expects to find: a.
Lesions that run together. b.
Annular lesions that have grown together.
c.
Lesions arranged in a line along a nerve route. d.
Lesions that are grouped or clustered together. - a
A patient has had a terrible itch for several months that he has been continuously
scratching. On examination, the nurse might expect to find: a. A keloid. b. A
fissure. c.
Keratosis. d.
Lichenification. - d
Lichenification results from prolonged, intense scratching that eventually thickens the
skin and produces tightly packed sets of papules. A keloid is a hypertrophic scar. A
fissure is a linear crack with abrupt edges, which extends into the dermis; it can be dry
or moist. Keratoses are lesions that are raised, thickened areas of pigmentation that
appear crusted, scaly, and warty.
,A physician has diagnosed a patient with purpura. After leaving the room, a nursing
student asks the nurse what the physician saw that led to that diagnosis. The nurse
should say, The physician is referring to the: a.
Blue dilation of blood vessels in a star-shaped linear pattern on the legs. b.
Fiery red, star-shaped marking on the cheek that has a solid circular center. c.
Confluent and extensive patch of petechiae and ecchymoses on the feet. d.
Tiny areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in
color. - c
A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his
head. His hair seems to be breaking off in patches, and he notices some scaling on his
head. The nurse begins the examination suspecting: a.
Tinea capitis. b.
Folliculitis. c.
Toxic alopecia. d.
Seborrheic dermatitis. - a
The nurse is examining a patient who tells the nurse, I sure sweat a lot, especially on
my face and feet but it doesnt have an odor. The nurse knows that this condition
could be related to: a.
Eccrine glands. b.
Apocrine glands.
c.
Disorder of the stratum corneum. d.
Disorder of the stratum germinativum. - a
A newborn infant is in the clinic for a well-baby checkup. The nurse observes the infant
for the possibility of fluid loss because of which of these factors? a.
Subcutaneous fat deposits are high in the newborn. b.
Sebaceous glands are overproductive in the newborn. c.
The newborns skin is more permeable than that of the adult. d.
The amount of vernix caseosa dramatically rises in the newborn. - c
During an examination, the nurse finds that a patient has excessive dryness of the skin.
The best term to describe this condition is: a.
Xerosis. b.
Pruritus.
c.
Alopecia. d.
Seborrhea. - a
, A patient comes in for a physical examination and complains of freezing to death while
waiting for her examination. The nurse notes that her skin is pale and cool and
attributes this finding to: a.
Venous pooling.
b.
Peripheral vasodilation. c.
Peripheral vasoconstriction. d.
Decreased arterial perfusion. - c
A patient comes to the clinic and states that he has noticed that his skin is redder than
normal. The nurse understands that this condition is due to hyperemia and knows that it
can be caused by:
a.
Decreased amounts of bilirubin in the blood b.
Excess blood in the underlying blood vessels
c.
Decreased perfusion to the surrounding tissues d.
Excess blood in the dilated superficial capillaries - d
A newborn infant has Down syndrome. During the skin assessment, the nurse notices a
transient mottling in the trunk and extremities in response to the cool temperature in the
examination room. The infants mother also notices the mottling and asks what it is. The
nurse knows that this mottling is called: a.
Caf au lait. b.
Carotenemia.
c.
Acrocyanosis.
d.
Cutis marmorata. - d
A 35-year-old pregnant woman comes to the clinic for a monthly appointment. During
the assessment, the nurse notices that she has a brown patch of hyperpigmentation on
her face. The nurse continues the skin assessment aware that another finding may be:
a.
Keratoses. b.
Xerosis. c.
Chloasma.
d.
Acrochordons. - c
During auscultation of the lungs of an adult patient, the nurse notices the presence of
bronchophony. The nurse should assess for signs of which condition? a.
Examination for Health & Well-Being Assessment
2nd Edition
A semiconscious woman is brought to the emergency department after she was found
on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright
cherryred color. The nurse suspects that this coloring is due to: a.
Polycythemia.
b.
Carbon monoxide poisoning.
c.
Carotenemia.
d. Uremia.
-b
A patient has been admitted to a hospital after the staff in the nursing home noticed a
pressure ulcer in his sacral area. The nurse examines the pressure ulcer and
determines that it is a stage II ulcer. Which of these findings are characteristic of a
stage II pressure ulcer? Select all that apply. a.
Intact skin appears red but is not broken. b.
Partial thickness skin erosion is observed with a loss of epidermis or dermis. c.
Ulcer extends into the subcutaneous tissue. d.
Localized redness in light skin will blanch with fingertip pressure. e.
Open blister areas have a red-pink wound bed.
f.
Patches of eschar cover parts of the wound. - b, e
Which statement about the apices of the lungs is true? The apices of the lungs: a.
Are at the level of the second rib anteriorly. b.
Extend 3 to 4 cm above the inner third of the clavicles. c.
Are located at the sixth rib anteriorly and the eighth rib laterally. d.
Rest on the diaphragm at the fifth intercostal space in the midclavicular line (MCL). - b
When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft
breath sounds are heard over the posterior lower lobes, with inspiration being longer
than expiration. The nurse interprets that these sounds are: a.
Normally auscultated over the trachea. b.
Bronchial breath sounds and normal in that location. c.
,Vesicular breath sounds and normal in that location. d.
Bronchovesicular breath sounds and normal in that location - c
When inspecting the anterior chest of an adult, the nurse should include which
assessment?
a.
Diaphragmatic excursion
b.
Symmetric chest expansion
c.
Presence of breath sounds
d.
Shape and configuration of the chest wall - d
A man has come in to the clinic for a skin assessment because he is worried he might
have skin cancer. During the skin assessment the nurse notices several areas of
pigmentation that look greasy, dark, and stuck on his skin. Which is the best prediction?
a.
Senile lentigines, which do not become cancerous b.
Actinic keratoses, which are precursors to basal cell carcinoma c.
Acrochordons, which are precursors to squamous cell carcinoma d.
Seborrheic keratoses, which do not become cancerous - d
The nurse just noted from the medical record that the patient has a lesion that is
confluent in nature. On examination, the nurse expects to find: a.
Lesions that run together. b.
Annular lesions that have grown together.
c.
Lesions arranged in a line along a nerve route. d.
Lesions that are grouped or clustered together. - a
A patient has had a terrible itch for several months that he has been continuously
scratching. On examination, the nurse might expect to find: a. A keloid. b. A
fissure. c.
Keratosis. d.
Lichenification. - d
Lichenification results from prolonged, intense scratching that eventually thickens the
skin and produces tightly packed sets of papules. A keloid is a hypertrophic scar. A
fissure is a linear crack with abrupt edges, which extends into the dermis; it can be dry
or moist. Keratoses are lesions that are raised, thickened areas of pigmentation that
appear crusted, scaly, and warty.
,A physician has diagnosed a patient with purpura. After leaving the room, a nursing
student asks the nurse what the physician saw that led to that diagnosis. The nurse
should say, The physician is referring to the: a.
Blue dilation of blood vessels in a star-shaped linear pattern on the legs. b.
Fiery red, star-shaped marking on the cheek that has a solid circular center. c.
Confluent and extensive patch of petechiae and ecchymoses on the feet. d.
Tiny areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in
color. - c
A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his
head. His hair seems to be breaking off in patches, and he notices some scaling on his
head. The nurse begins the examination suspecting: a.
Tinea capitis. b.
Folliculitis. c.
Toxic alopecia. d.
Seborrheic dermatitis. - a
The nurse is examining a patient who tells the nurse, I sure sweat a lot, especially on
my face and feet but it doesnt have an odor. The nurse knows that this condition
could be related to: a.
Eccrine glands. b.
Apocrine glands.
c.
Disorder of the stratum corneum. d.
Disorder of the stratum germinativum. - a
A newborn infant is in the clinic for a well-baby checkup. The nurse observes the infant
for the possibility of fluid loss because of which of these factors? a.
Subcutaneous fat deposits are high in the newborn. b.
Sebaceous glands are overproductive in the newborn. c.
The newborns skin is more permeable than that of the adult. d.
The amount of vernix caseosa dramatically rises in the newborn. - c
During an examination, the nurse finds that a patient has excessive dryness of the skin.
The best term to describe this condition is: a.
Xerosis. b.
Pruritus.
c.
Alopecia. d.
Seborrhea. - a
, A patient comes in for a physical examination and complains of freezing to death while
waiting for her examination. The nurse notes that her skin is pale and cool and
attributes this finding to: a.
Venous pooling.
b.
Peripheral vasodilation. c.
Peripheral vasoconstriction. d.
Decreased arterial perfusion. - c
A patient comes to the clinic and states that he has noticed that his skin is redder than
normal. The nurse understands that this condition is due to hyperemia and knows that it
can be caused by:
a.
Decreased amounts of bilirubin in the blood b.
Excess blood in the underlying blood vessels
c.
Decreased perfusion to the surrounding tissues d.
Excess blood in the dilated superficial capillaries - d
A newborn infant has Down syndrome. During the skin assessment, the nurse notices a
transient mottling in the trunk and extremities in response to the cool temperature in the
examination room. The infants mother also notices the mottling and asks what it is. The
nurse knows that this mottling is called: a.
Caf au lait. b.
Carotenemia.
c.
Acrocyanosis.
d.
Cutis marmorata. - d
A 35-year-old pregnant woman comes to the clinic for a monthly appointment. During
the assessment, the nurse notices that she has a brown patch of hyperpigmentation on
her face. The nurse continues the skin assessment aware that another finding may be:
a.
Keratoses. b.
Xerosis. c.
Chloasma.
d.
Acrochordons. - c
During auscultation of the lungs of an adult patient, the nurse notices the presence of
bronchophony. The nurse should assess for signs of which condition? a.
