Chapter 03: Examination Techniques and Equipment
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
1. According to the guidelines for Standard Precautions, the caregiver’s hands should be washed:
a. only after touching body fluids with ungloved hands and between patient
contacts.
b. only after touching blood products with ungloved hands and after caring for
infectious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or contaminated items, regardless of whether
gloves are worn.
ANS: D
Handwashing is to be done after removal of gloves, between patient contacts, and after touching
body fluids, regardless of whether
gloves are used. The nurse should never touch body fluids or blood products with ungloved
hands. The nurse should use hand
hygiene regardless of a patient’s possible infection.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
2. Which patient is at the highest risk for developing latex allergy?
a. The new patient who has no chronic illness and has never been hospitalized
b. The patient who has had multiple procedures or surgeries
c. The patient who is a vegetarian
d. The patient who is allergic to contrast dye
ANS: B
The patient who has had multiple procedures or surgeries has a higher rate of exposure to rubber
gloves and to equipment and
supplies that contain latex and therefore is at a higher risk for developing an allergic response.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
3. Which technique is used during both the history taking and the physical examination process?
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
ANS: B
Inspection is the technique that is used while gathering and validating data during both the
history taking and the actual hands-on
physical examination. Auscultation, palpation, and percussion are not used during the history
taking and physical examination
, processes. It is not possible to listen to the patient talking and use the stethoscope at the same
time. The focus is on the patient’s
response to your touch and what you are feeling; it is not possible to perform palpation and listen
to the patient talking at the same
time.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. 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.
ANS: D
Tangential lighting is used to cast shadows to observe contours and variations in body surfaces
best.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
5. You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse,
that he feels like he is having
drainage from his rectum. Which initial nursing action is appropriate?
a. Drape the patient and observe the rectal area.
b. Tell the patient that his doctor will be notified of his problem.
c. Tell the patient that you will ask the male nurse on the next shift to check on the
problem.
d. Give the patient an ice pack to apply to the area.
ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The
complaint warrants validation before
referral or delegation. Before you call the clinician, you need to assess the patient. The
assessment should not wait for another shift.
Before treatment, it is important to assess the complaint.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
6. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is
best for palpating vibration?
a. Dorsal surface
b. Finger pads
c. Fingertips
d. Ulnar surface
ANS: D
The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as
thrills and fremitus. The dorsal
surface of the hand is best for assessing temperature. The finger pads and fingertips are best for
palpating pulses.
DIF: Cognitive Level: Understanding (Comprehension)
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
1. According to the guidelines for Standard Precautions, the caregiver’s hands should be washed:
a. only after touching body fluids with ungloved hands and between patient
contacts.
b. only after touching blood products with ungloved hands and after caring for
infectious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or contaminated items, regardless of whether
gloves are worn.
ANS: D
Handwashing is to be done after removal of gloves, between patient contacts, and after touching
body fluids, regardless of whether
gloves are used. The nurse should never touch body fluids or blood products with ungloved
hands. The nurse should use hand
hygiene regardless of a patient’s possible infection.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
2. Which patient is at the highest risk for developing latex allergy?
a. The new patient who has no chronic illness and has never been hospitalized
b. The patient who has had multiple procedures or surgeries
c. The patient who is a vegetarian
d. The patient who is allergic to contrast dye
ANS: B
The patient who has had multiple procedures or surgeries has a higher rate of exposure to rubber
gloves and to equipment and
supplies that contain latex and therefore is at a higher risk for developing an allergic response.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
3. Which technique is used during both the history taking and the physical examination process?
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
ANS: B
Inspection is the technique that is used while gathering and validating data during both the
history taking and the actual hands-on
physical examination. Auscultation, palpation, and percussion are not used during the history
taking and physical examination
, processes. It is not possible to listen to the patient talking and use the stethoscope at the same
time. The focus is on the patient’s
response to your touch and what you are feeling; it is not possible to perform palpation and listen
to the patient talking at the same
time.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. 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.
ANS: D
Tangential lighting is used to cast shadows to observe contours and variations in body surfaces
best.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
5. You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse,
that he feels like he is having
drainage from his rectum. Which initial nursing action is appropriate?
a. Drape the patient and observe the rectal area.
b. Tell the patient that his doctor will be notified of his problem.
c. Tell the patient that you will ask the male nurse on the next shift to check on the
problem.
d. Give the patient an ice pack to apply to the area.
ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The
complaint warrants validation before
referral or delegation. Before you call the clinician, you need to assess the patient. The
assessment should not wait for another shift.
Before treatment, it is important to assess the complaint.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
6. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is
best for palpating vibration?
a. Dorsal surface
b. Finger pads
c. Fingertips
d. Ulnar surface
ANS: D
The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as
thrills and fremitus. The dorsal
surface of the hand is best for assessing temperature. The finger pads and fingertips are best for
palpating pulses.
DIF: Cognitive Level: Understanding (Comprehension)
