Ch.15-30 Flashcards
Which definition correctly describes a person’s functional ability?
a.
Functional ability is the measure of the expected changes of aging that a person is experiencing.
b.
Functional ability refers to an individual’s motivation to live independently.
c.
Functional ability refers to the level of cognition present in an older person.
d.
Functional ability refers to a person’s ability to perform activities necessary to live in modern society.
D
The nurse is preparing to perform a functional assessment of an older patient, and knows that a good approach would be to:
a.
observe the patient’s ability to perform tasks.
b.
ask the patient’s wife how well he performs tasks.
c.
review the medical record for information about the patient’s abilities.
d.
ask the patient’s physician for information about the patient’s abilities.
A
The nurse will choose which of the following tools to assess a patient’s ability to perform activities of daily living?
a.
Direct Assessment of Functional Abilities (DAFA)
b.
Lawton and Brody IADL
c.
Katz Index
d.
Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire-IADL (OARS-IADL)
C
Which of the following statements about the Lawton IADL instrument is true?
a.
The nurse uses direct observation to implement this tool.
b.
It is designed as a self-report measure of performance, rather than ability.
c.
It is not useful in the acute hospital setting.
d.
It is best used for those residing in an institutional setting.
B
The nurse is assessing an older adult’s advanced activities of daily living, which would include: a. recreational activities. b. meal preparation. c. balancing the chequebook. d. self-grooming activities.
A
When using the various instruments to assess an older person’s activities of daily living, the nurse needs to remember that a disadvantage of these instruments includes:
a.
the reliability of the tools.
b.
the self or proxy report of functional activities.
c.
the lack of confidentiality during the assessment.
d.
insufficient detail about the deficiencies identified.
B
The nurse is administering a test that is timed over 15 minutes, and assesses a person’s upper body fine and coarse motor activities, balance, mobility, coordination, and endurance. During this test, activities such as dressing and stair climbing are timed. Which test is described by these activities? a. The Up and Go Test b. The Performance Activities of Daily Living c. The Physical Performance Test d. Tinetti Gait and Balance Evaluation
C
A patient will be ready to be discharged from the hospital soon, and the patient’s family members are concerned about whether he is able to go outside alone safely. The nurse will perform which test to assess this ability? a. The Up and Go Test b. The Performance Activities of Daily Living c. The Physical Performance Test d. Tinetti Gait and Balance Evaluation
A
The nurse is assessing the forms of support an older patient has before she is discharged. Which of the following illustrates an informal source of support? a. The local senior centre b. Her cleaning lady c. Her Meals on Wheels meal delivery service d. Her neighbour, who visits with her daily
D
An 85-year-old man has been hospitalized after a fall at home, and his 86-year-old wife is at his bedside. She tells the nurse that she is his primary caregiver. The nurse should assess the caregiver for signs of possible caregiver burnout, such as: a. depression. b. weight gain. c. hypertension. d. social phobias.
A
During a morning assessment, the nurse notices that an older patient is less attentive and is unable to recall yesterday’s events. The nurse administers the Mini Mental State Examination, which will screen for: a. dementia. b. depression. c. delirium. d. psychosis.
C
During an assessment of a newly admitted 92-year-old woman, the nurse notes that her son does not want to leave the room. The woman has signs of old bruises and healed cuts that happened “last week,” according to the son. Which of the following actions by the nurse is appropriate?
a.
Ask the son for details about the nature of the patient’s injuries.
b.
Recognize that older people are often unsteady on their feet, and that falls do occur.
c.
Notify the authorities of a potential abusive situation.
d.
Recognize that these findings do not necessarily indicate that abuse has occurred, but are signs that further assessment is needed.
D
Which of the following statements regarding common environmental hazards is most appropriate for the nurse to make during a functional assessment of an older person’s home environment?
a.
“These low toilet seats are safe because they are nearer to the ground in case of falls.”
b.
“Ask a relative or friend to help you to install grab bars in your shower.”
c.
“These small rugs are ideal for preventing you from slipping on the hard floor.”
d.
“It would be safer to keep the lighting low in this room to avoid glare in your eyes.”
B
Which of the following questions would be most appropriate for the nurse to ask when beginning to assess a person’s spirituality? a. “Do you believe in God?” b. “Do you consider yourself to be a spiritual person?” c. “What religious faith do you follow?” d. “Do you believe in the power of prayer?”
B
The nurse is preparing to assess an older adult, and discovers that he is in severe pain. Which of the following statements about pain and the older adult is true?
a.
Pain is inevitable with aging.
b.
Older adults with cognitive impairment feel less pain.
c.
Alleviating pain should take priority over other aspects of the assessment.
d.
The assessment should take priority so that care decisions can be made.
C
The nurse is assessing the abilities of an older adult. Which of the following activities are considered instrumental activities of daily living? Select all that apply. a. Feeding oneself b. Preparing a meal c. Balancing a chequebook d. Walking e. Toileting f. Grocery shopping
B,C,F
Which of the following best describes the action of the hormone progesterone during pregnancy?
a.
It produces the hormone human chorionic gonadotropin.
b.
It stimulates duct formation in the breast.
c.
It promotes sloughing of the endometrial wall.
d.
It maintains the endometrium around the fetus.
D
A female patient is experiencing nausea, breast tenderness, fatigue, and amenorrhea. Her last menstrual period was 6 weeks ago. The nurse recognizes that this patient is experiencing: a. positive signs of pregnancy. b. possible signs of pregnancy. c. probable signs of pregnancy. d. presumptive signs of pregnancy.
D
When performing the examination of a woman who is 8 weeks pregnant, the nurse notes that her cervix is a bluish colour. The nurse would document this finding as: a. Hegar’s sign. b. Homan’s sign. c. Chadwick’s sign. d. Goodell’s sign.
C
A woman who is 8 weeks pregnant is visiting the clinic for a checkup. Her systolic blood pressure is 30 mm Hg higher than her pre-pregnancy blood pressure. The nurse would:
a.
consider this a normal finding.
b.
expect the blood pressure to decrease as the estrogen levels increase throughout the pregnancy.
c.
consider this an abnormal finding, because blood pressure is typically lower at this point in the pregnancy.
d.
recommend that she decrease her salt intake in an attempt to decrease her peripheral vascular resistance.
C
A patient is being seen at the clinic for her 10-week prenatal visit. She asks when she will be able to hear the baby’s heartbeat. The nurse should reply:
a.
“The baby’s heartbeat is not usually heard until the second trimester.”
b.
“The baby’s heartbeat may be heard anywhere from the ninth to the twelfth week.”
c.
“It is often difficult to hear the heartbeat at this point, but we can try.”
d.
“It is normal to hear the heartbeat at 6 weeks. We may be able to hear it today.”
B
A patient who is in her first trimester of pregnancy tells the nurse that she is experiencing significant nausea and vomiting, and asks when it will improve. The nurse should reply:
a.
“Did your mother have significant nausea and vomiting?”
b.
“Many women experience nausea and vomiting until the third trimester.”
c.
“Usually, by the beginning of the second trimester, the nausea and vomiting improve.”
d.
“At about the time you begin to feel the baby move, the nausea and vomiting will subside.”
C
During the examination of a woman in her second trimester of pregnancy, the nurse notes the presence of a small amount of yellow drainage from the nipples. The nurse knows that this is:
a.
an indication that the woman’s milk is coming in.
b.
a sign of possible breast cancer in a pregnant woman.
c.
most likely colostrum, which is considered a normal finding at this stage of the pregnancy.
d.
an early stage in the pregnancy for lactation to begin. The woman should be referred to a specialist.
C
A woman in her second trimester of pregnancy complains of heartburn and indigestion. The nurse should offer which of the following explanations for these problems?
a.
Tone and motility of the gastrointestinal tract increase during the second trimester.
b.
Sluggish emptying of the gallbladder, resulting from the effects of progesterone, often causes heartburn.
c.
Lower blood pressure at this time decreases blood flow to the stomach and gastrointestinal tract.
d.
The enlarging uterus and altered esophageal sphincter tone predispose the woman to have heartburn.
D
A patient who is 20 weeks pregnant tells the nurse that she feels more short of breath as her pregnancy progresses. The nurse recognizes that which of the following is true?
a.
High levels of estrogen cause shortness of breath.
b.
Feelings of shortness of breath are abnormal during pregnancy.
c.
The hormones of pregnancy cause an increased respiratory effort.
d.
The patient should get more exercise in an attempt to increase her respiratory reserve.
C
The nurse auscultates a functional systolic murmur, grade ii/iv, in a woman in week 30 of her pregnancy. The remainder of her physical assessment is within normal limits. The nurse would:
a.
consider this an abnormal finding, and refer her for additional consultation.
b.
ask the woman to run in place, and then assess for an increase in the intensity of the murmur.
c.
know that this is a normal finding, resulting from the increase in blood volume during pregnancy.
d.
ask the woman to restrict her activities, and return to the clinic in 1 week for re-evaluation.
C
A woman who is 28 weeks pregnant has edema in her lower legs bilaterally after working 8 hours a day as a cashier at a local grocery store. What should the nurse tell her?
a.
“You will be at risk for development of varicose veins when your legs are edematous.”
b.
“I would like to listen to your heart sounds. Edema can indicate a problem with your heart.”
c.
“Edema is usually the result of too much salt and fluids in your diet. You may need to try to cut down on salty foods.”
d.
“As your baby grows, it slows blood return from your legs, causing the swelling. This often occurs with prolonged standing.”
D
The nurse knows that classic symptoms associated with preeclampsia include:
a.
proteinuria, headaches, and seizures.
b.
elevated blood pressure and proteinuria.
c.
elevated liver enzymes and high platelets.
d.
neurological signs, elevated blood pressure, and edema.
B
The nurse knows that the best time to assess a woman’s blood pressure during an initial prenatal visit is:
a.
at the end of the examination, when she will be the most relaxed.
b.
at the beginning of the interview, as a nonthreatening method of establishing rapport.
c.
during the middle of the physical examination, when she is the most comfortable.
d.
before beginning the pelvic examination, because her blood pressure will be higher after the pelvic examination.
A
When examining the face of a 28-week pregnant woman, the nurse notes the presence of a butterfly-shaped increase in pigmentation on her face. When documenting, the correct term for this finding is: a. striae. b. chloasma. c. linea nigra. d. the mask of pregnancy.
B
Which of the following findings is considered normal and expected when the nurse is performing a physical examination on a pregnant woman?
a.
A palpable, full thyroid
b.
Spontaneously bleeding gingiva
c.
Significant, diffuse enlargement of the thyroid
d.
Pale, hypertrophied mucous membranes of the mouth
A
When auscultating the anterior thorax of a pregnant woman, the nurse notes the presence of a murmur over the second, third, and fourth intercostal spaces. It is continuous, but can be obliterated by pressure with the stethoscope or finger on the thorax just lateral to the murmur. The nurse knows that this is: a. the murmur of aortic stenosis. b. most likely a mammary souffle. c. associated with aortic insufficiency. d. an indication of a patent ductus arteriosis.
B
When the nurse is assessing the deep tendon reflexes (DTRs) of a 32-week pregnant woman, which of the following findings would be considered normal, on a 0–4+ scale? a. Absent DTRs b. 2+ c. 4+ d. Brisk reflexes and the presence of clonus
B
When performing an examination of a 34-week pregnant woman, the nurse notes that as the woman raises her head and shoulders off of the bed, there is a midline linear protrusion in the abdomen over the area of the rectus abdominis muscles. The nurse would:
a.
document the presence of diastasis rectus abdominis.
b.
discuss this condition with the physician, because it will most likely need to be surgically repaired.
c.
suspect that the woman has a hernia from the increased pressure within the abdomen from pregnancy.
d.
tell the woman that she may have a difficult time with delivery because of the weakness in her abdominal muscles.
A
When palpating the fundus, the nurse knows that:
a.
it should be hard and slightly tender to palpation during the first trimester.
b.
fetal movement should be felt by the examiner at the beginning of the second trimester.
c.
after 20 weeks’ gestation, the number of centimetres should approximate the number of weeks of gestation.
d.
fundal height is usually less than the number of weeks of gestation, unless there is an abnormal condition such as the presence of too much amniotic fluid.
C
The nurse is palpating the abdomen of a woman who is 35 weeks pregnant, and notes that the fetal head is facing downward toward the pelvis. The nurse would document this as: a. fetal lie. b. fetal variety. c. fetal attitude. d. fetal presentation.
D
During the health history of a woman who is pregnant with her first child, the woman states, “I just cannot stop crunching on ice! What’s wrong with me?” The nurse recognizes that:
a.
she is experiencing a common food intolerance.
b.
the woman is experiencing pica, or craving for nonfood items, which is sometimes associated with anemia.
c.
she may be experiencing gastrointestinal changes associated with pregnancy.
d.
she probably craved ice before her pregnancy, and this is nothing new.
B
Which of the following findings would be most consistent with an 8-week pregnant uterus?
a.
The uterus seems slightly enlarged and softened.
b.
It reaches to the pelvic brim, and is about the size of a grapefruit.
c.
It rises above the pelvic brim, and is about the size of a cantaloupe.
d.
It is approximately 8 cm across the fundus, and is about the size of an avocado.
D
A woman in week 25 of her pregnancy has come to the clinic with a complaint of 3 weeks of bouts of severe vomiting. The nurse notes that she is showing signs of dehydration. Her blood pressure is lower than usual, and she is extremely fatigued. The nurse recognizes that this patient is experiencing: a. preeclampsia. b. polyhydramnios. c. proteinuria. d. hyperemesis.
D
Which of the following time periods correctly describes the average length of pregnancy?
a.
38 weeks
b.
9 lunar months
c.
280 days from the last day of the last menstrual period
d.
280 days from the first day of the last menstrual period
D
A patient’s pregnancy test is positive, and she wants to know when the baby is due. The first day of her last menstrual period was June 14, and that period ended June 20. What is her expected date of delivery, using Nägele’s rule? a. March 7 b. March 14 c. March 21 d. March 27
C
During the assessment of a woman in week 22 of her pregnancy, the nurse is unable to hear fetal heart tones with the Doppler device. The nurse should:
a.
wait 10 minutes and try again.
b.
notify the physician immediately.
c.
use a fetoscope to identify fetal heart tones.
d.
use an ultrasound to verify cardiac activity.
D
A patient, who is 24 weeks pregnant, asks about wearing a seatbelt while driving. The nurse should reply:
a.
“Seatbelts should not be worn during pregnancy.”
b.
“Place the lap belt below the uterus, and use the shoulder strap at the same time.”
c.
“Place the lap belt below the uterus, but omit the shoulder strap during pregnancy.”
d.
“Place the lap belt at your waist above the uterus, and use the shoulder strap at the same time.”
B
Which of the following statements is true regarding pregnancy after 35 years of age?
a.
Women over 35 years of age deliver most often by vaginal delivery.
b.
The occurrence of having a child with Down syndrome is much more frequent after 35 years of age.
c.
Genetic counselling and prenatal screening are not routine until after 40 years of age.
d.
Women over 35 years of age who are pregnant have the same rate of pregnancy-related complications as those who are under 35 years of age.
B
A 25-year-old woman is visiting the clinic for her first prenatal visit. Which laboratory screening is appropriate at this time? a. Human chorionic gonadotropin b. Complete blood cell count c. Alpha-fetoprotein d. Carrier screening for cystic fibrosis
B
A woman, who is in week 25 of her pregnancy, comes to the clinic for her prenatal visit. The nurse notes that her face is swollen and that her blood pressure is 144/94 mm Hg. She states that she has had headaches and blurry vision, but thought she was just tired. What should the nurse suspect? a. Eclampsia b. Preeclampsia c. Diabetes type 1 d. Premature labour
B
During auscultation of fetal heart tones (FHTs), the nurse determines that the rate is 136 beats per minute. The nurse’s next action should be to:
a.
document the results, which are within normal range.
b.
take the maternal pulse to verify these findings as the uterine souffle.
c.
have the patient change positions, and count the FHTs again.
d.
notify the physician immediately for possible fetal distress.
A
In week 34 of pregnancy, a woman she is told that she has preeclampsia. The nurse knows that which of the following statements about preeclampsia is true?
a.
Preeclampsia has little effect on the fetus.
b.
Edema is one of the main indications of preeclampsia.
c.
Eclampsia only occurs before delivery of the baby.
d.
Untreated preeclampsia may progress to eclampsia, which is manifested by generalized tonic-clonic seizures
D
During an internal examination of a woman during her first prenatal visit, the nurse notes that the cervix is soft. This is known as: a. Hegar’s sign. b. Chadwick’s sign. c. Homan’s sign. d. Goodell’s sign.
D
During a group prenatal teaching session, the nurse teaches Kegel exercises. Which of the following statements would be appropriate for this teaching session? Select all that apply.
a.
“Kegel exercises help to keep your uterus strong during the pregnancy.”
b.
“Kegel exercises should be performed twice a day.”
c.
“Kegel exercises should be performed 50 to 100 times a day.”
d.
“To perform Kegel exercises, squeeze slowly to a peak at the count of eight, then release slowly to a count of eight.”
e.
“To perform Kegel exercises, perform rapidly alternating squeeze-release exercises up to the count of eight.”
C,D
At the beginning of rounds, when the nurse enters the room, what should be done first?
a.
Check the intravenous infusion site for swelling or redness.
b.
Check the infusion pump settings for accuracy.
c.
Make eye contact with the patient and introduce himself or herself as the patient’s nurse.
d.
Offer the patient something to drink.
C
During an assessment, the nurse is unable to palpate pulses in the left lower leg. The nurse should:
a.
document that the pulses are not palpable.
b.
reassess the pulses in 1 hour.
c.
have the patient turn to the side, and then palpate for the pulses again.
d.
use a Doppler device to assess the pulses.
D
During a morning assessment, the nurse notes that a patient’s urine output is below the expected amount. What should be done next?
a.
An order for a Foley catheter should be obtained.
b.
An order for a straight catheter should be obtained.
c.
Perform a bladder scan test.
d.
Refer the patient to a urologist.
C
What should the nurse assess before entering the patient’s room on morning rounds?
a.
Posted conditions, such as isolation precautions
b.
The patient’s input and output chart from the previous shift
c.
The patient’s general appearance
d.
The presence of any visitors in the room
A
The nurse has administered a pain medication to a patient by intravenous infusion. The nurse should reassess the patient’s response to the pain medication within: a. 5 minutes. b. 15 minutes. c. 30 minutes. d. 60 minutes.
B
During an assessment of a hospitalized patient, the nurse pinches a fold of skin under the clavicle or on the forearm to note: a. mobility and turgor. b. the patient’s response to pain. c. the percentage of the patient’s fat-to-muscle ratio. d. the presence of edema.
A
When assessing the neurological system of a hospitalized patient during morning rounds, the nurse will include which of the following assessments? a. Blood pressure b. The patient’s rating of pain on a 1 to 10 scale c. The patient’s ability to communicate d. The patient’s personal hygiene level
C
When assessing a patient’s general appearance, the nurse will include which of the following assessments?
a.
Is the patient’s muscle strength equal in both arms?
b.
Is ptosis or facial droop present?
c.
Does the patient respond appropriately to questions?
d.
Are the pupils equal in reaction and size?
C
Which statement reflects the assessment of a patient in the hospital setting?
a.
The patient will need a brief assessment at least every 4 hours.
b.
The patient will need a consistent, specialized exam every 8 hours that focuses on certain parameters.
c.
The patient will need a complete head-to-toe physical examination every 24 hours.
d.
Most patients require a minimal examination during each shift, unless they are in critical condition.
B
The nurse is assessing the intravenous (IV) infusion at the beginning of the shift. Which of the following should be included in the assessment of the infusion? Select all that apply.
a.
The proper IV solution is infusing, according to physician’s orders.
b.
Infusion is occurring at the proper rate, according to physician’s orders.
c.
The infusion solution and rate is proper, according to the nurse’s own assessment of the patient’s needs.
ALL
An 85-year-old man has come into the clinic for a physical examination, and the nurse notes that he uses a cane. When documenting general appearance, the nurse will document this information under the section that covers: a. posture. b. mobility. c. mood and affect. d. physical deformity.
B
After the health history has been obtained, and before beginning the physical examination, the nurse should ask the patient to first: a. empty the bladder. b. completely disrobe. c. lie on the examination table. d. walk around the room.
A
While the nurse palpates the maxillary sinuses, the patient tells the nurse that he has some tenderness in that area. The nurse should proceed by: a. tapping on the sinus area. b. auscultating the sinus area. c. asking him to blow his nose. d. transilluminating the sinuses.
D
A patient states “whenever I open my mouth real wide, I feel this popping sensation in front of my ears.” To further examine this, the nurse would:
a.
place the stethoscope over the temporomandibular joint, and listen for bruits.
b.
place the hands over his ears, and ask him to open his mouth “really wide.”
c.
place one hand on his forehead and the other on his jaw, and ask him to try to open his mouth.
d.
place a finger on his temporomandibular joint, and ask him to open and close his mouth.
D
The nurse has just completed an examination of a patient’s extraocular muscles. When documenting the findings, the nurse would note the assessment of which cranial nerves? a. II, III, VI b. II, IV, V c. III, IV, V d. III, IV, VI
D
A patient’s uvula rises midline when she says “ahh,” and she has a positive gag reflex. The nurse has just tested which cranial nerves? a. IX, X b. IX, XII c. X, XII d. XI, XII
A
During an examination, the nurse notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with the successful performance of this action? a. I b. V c. XI d. XII
D
A patient is unable to shrug her shoulders against the nurse’s resistant hands. What cranial nerve is involved with successful shoulder shrugging? a. VII b. IX c. XI d. XII
C
During an examination, a patient has successfully completed the finger-to-nose and the rapid-alternating-movements tests, and is able to run each heel down the opposite shin. The nurse will conclude that the patient’s: a. occipital function is intact. b. cerebral function is intact. c. temporal function is intact. d. cerebellar function is intact.
D
A 5-year-old child is in the clinic for a checkup. The nurse would expect him to:
a.
have to be held on his mother’s lap.
b.
be able to sit on the examination table.
c.
be able to stand on the floor for the examination.
d.
be able to remain alone in the examination room.
B
When the nurse performs the confrontation test, the nurse has assessed: a. EOMs. b. PERRLA. c. near vision. d. visual fields.
D
Which of the following statements is true regarding the recording of data from the health history and physical examination?
a.
Use long, descriptive sentences to document findings.
b.
Record the data as soon as possible after the interview and physical examination.
c.
If the information is not documented, it can be assumed that it was done as a standard of care.
d.
The examiner should avoid taking any notes during the history and examination because of the possibility of decreasing rapport with the patient.
B
Which of the following is included in assessment of general appearance? a. Height b. Weight c. Skin colour d. Vital signs
C
Gloves should be worn for which of the following examinations? a. Measurement of vital signs b. Palpation of the sinuses c. Palpation of the mouth and tongue d. Inspection of the eye with an ophthalmoscope
C
Which of the following is an appropriate location for eliciting deep tendon reflexes? a. Achilles b. Femoral c. Scapular d. Abdominal
A
During inspection of a patient’s face, the nurse notes that the facial features are symmetrical. This finding indicates that which cranial nerve is intact? a. VII b. IX c. XI d. XII
A
During inspection of the posterior chest, the nurse should assess for: a. symmetrical expansion. b. symmetry of the shoulders and muscles. c. tactile fremitus. d. diaphragmatic excursion.
B
When assessing the neonate, the nurse should use which of the following methods to test for hip stability? a. Elicit the Moro reflex b. Perform Romberg’s test c. Check for Ortolani’s sign d. Assess the stepping reflex
C
During an examination, the patient tells the nurse that she sometimes feels as if objects are spinning around her. The nurse would note that she occasionally experiences: a. vertigo. b. tinnitus. c. syncope. d. dizziness.
A
A patient tells the nurse that “sometimes I wake up at night and I have real trouble breathing. I have to sit up in bed to get a good breath.” When documenting this information, the nurse would note: a. orthopnea. b. acute emphysema. c. paroxysmal nocturnal dyspnea. d. acute shortness of breath episode.
C
During the examination of a patient, the nurse notes that the patient has several small, flat macules on her posterior thorax. These macules are less than 1 cm wide. Another name for these macules is: a. warts. b. bullas. c. freckles. d. papules.
C
During an examination, the nurse notes that a patient’s legs turn white when they are raised above her head. The nurse would suspect: a. lymphedema. b. Raynaud’s disease. c. chronic arterial insufficiency. d. chronic venous insufficiency.
C
The nurse documents that a patient has coarse, thickened skin and brown discoloration over the lower legs. Pulses are present. This finding is likely the result of: a. lymphedema. b. Raynaud’s disease. c. chronic arterial insufficiency. d. chronic venous insufficiency.
D
The nurse notes that a patient has ulcerations on the tips of the toes and on the lateral ankles. This finding would indicate: a. lymphedema. b. Raynaud’s disease. c. arterial insufficiency. d. venous insufficiency.
C
When the nurse flexes the patient’s knee and gently compresses the gastrocnemius muscle anteriorly against the tibia, the patient indicates that he is having calf pain. The nurse would document: a. positive Allen’s sign. b. negative Allen’s sign. c. positive Homan’s sign. d. negative Homan’s sign.
C
The nurse has just recorded a positive obturator test on a patient who has abdominal pain. This test is used to confirm a(n): a. inflamed liver. b. perforated spleen. c. perforated appendix. d. enlarged gallbladder.
C
The nurse is documenting the assessment of an infant. During the abdominal assessment, the nurse notes a very loud splash auscultating over the upper abdomen when the nurse rocks her from side to side. This finding would indicate: a. epigastric hernia. b. pyloric obstruction. c. hypoactive bowel sounds. d. hyperactive bowel sounds.
B
The nurse will use which of the following tools to measure a patient’s near vision? a. A Snellen eye chart with letters b. A Snellen “E” chart c. A Jaeger card d. An ophthalmoscope
C
If the nurse records the results to the Hirschberg test, the nurse has: a. tested the patellar reflex. b. assessed for appendicitis. c. tested the corneal light reflex. d. assessed for thrombophlebitis.
C
During the examination of a patient’s mouth, the nurse observes a nodular, bony ridge down the middle of the hard palate. The nurse would chart this finding as: a. cheilosis. b. leukoplakia. c. ankyloglossia. d. torus palatinus.
D
During an examination, the nurse finds that a patient is unable to distinguish objects placed in his hand. The nurse would document: a. stereognosis. b. astereognosis. c. graphesthesia. d. agraphesthesia.
B
After the examination of an infant, the nurse notes opisthotonos. The nurse recognizes that this finding often occurs with: a. cerebral palsy. b. meningeal irritation. c. lower motor neuron lesion. d. upper motor neuron lesion.
B
After assessing a female patient, the nurse notes flesh-coloured, soft, pointed, moist papules in a cauliflower-like patch around her introitus. This finding is most likely: a. a urethral caruncle. b. a syphilitic chancre. c. herpes. d. human papillomavirus.
D
While recording in a patient’s chart, the nurse notes that a patient’s hematest results have been positive. This means that: a. there are crystals in his urine. b. there are parasites in his stool. c. there is occult blood in his stool. d. there are bacteria in his sputum.
C
While examining a 48-year-old patient’s eyes, the nurse notes that he has to move the hand-held vision screener farther away from his face. The nurse would suspect: a. myopia. b. omniopia. c. hyperopia. d. presbyopia.
D
Which of the following assessments is most appropriate to perform on a 9-month-old well child? a. Assessment for Ortolani’s sign b. Assessment for stereognosis c. Assessment of blood pressure d. Assessment for the presence of the startle reflex
A
The female structure that corresponds with the male penis is called the: a. labia. b. clitoris. c. prepuce. d. frenulum.
B
When observing the vestibule, the nurse should be able to see the:
a.
urethral meatus and vaginal orifice.
b.
vaginal orifice and vestibular (Bartholin’s) glands.
c.
urethral meatus and paraurethral (Skene’s) glands.
d.
paraurethral (Skene’s) and vestibular (Bartholin’s) glands.
A
During an inspection of the vagina, the nurse would expect to see what at the end of the vagina? a. Cervix b. Uterus c. Ovaries d. Fallopian tubes
A
The uterus is usually positioned tilting forward and superior to the bladder. This position is known as: a. anteverted and anteflexed. b. retroverted and anteflexed. c. retroverted and retroflexed. d. superior verted and anteflexed.
A
An 11-year-old girl is in the clinic for a sports physical. The nurse notes that she has begun to develop breasts, and during the conversation the girl reveals that she is unsure about the progression of development. The nurse should use which of the following to best assist the young girl in understanding the expected sequence for development?
a.
The nurse should use Tanner’s table on the five stages of sexual development.
b.
The nurse should describe her development and compare it with that of other girls her age.
c.
Jacobsen’s table on expected development on the basis of height and weight data should be used.
d.
The nurse should reassure her that her development is within normal limits, and tell her not to worry about the next step.
A
A woman who is 8 weeks pregnant is in the clinic for a check. The nurse reads on her chart that her cervix is softened and looks cyanotic. The nurse knows that the woman is exhibiting which of the following signs? a. Tanner’s sign and Hegar’s sign b. Hegar’s sign and Goodell’s sign c. Chadwick’s sign and Hegar’s sign d. Goodell’s sign and Chadwick’s sign
D
A woman who is 22 weeks pregnant has a vaginal infection. She tells the nurse that she is afraid that this infection will “hurt my baby.” The nurse knows that which of the following statements is true?
a.
If intercourse is avoided, the risk for infection is minimal.
b.
A thick mucus plug forms that protects the fetus from infection.
c.
The acidic pH of vaginal secretions promotes the growth of pathogenic bacteria.
d.
The mucus plug that forms in the cervical canal is a good medium for bacterial growth.
B
The changes normally associated with menopause occur generally because the cells in the reproductive tract are: a. aging. b. becoming fibrous. c. estrogen dependent. d. able to respond to estrogen.
C
Which of the following are changes associated with menopause?
a.
Uterine and ovarian atrophy, along with thinning vaginal epithelium
b.
Ovarian atrophy, increased vaginal secretions, and increasing clitoral size
c.
Cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal secretions
d.
Vaginal mucosa fragility, increased acidity of vaginal secretions, and uterine hypertrophy
A
A 54-year-old woman who has just completed menopause is visiting the clinic for a yearly physical examination. Which of the following should the nurse include in patient education?
a.
A postmenopausal woman is not at any greater risk for heart disease than a younger woman is.
b.
A postmenopausal woman should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions.
c.
A postmenopausal woman has only stopped menstruating; there really are no other significant changes that she should be concerned with.
d.
A postmenopausal woman is likely to have difficulty with sexual pleasure as a result of drastic changes in the female sexual response cycle.
B
A patient has had three pregnancies and two live births. How would the nurse record this information? a. Gravida 2, para 2, AB 1 b. Gravida 3, para 2, AB 0 c. Gravida 3, para 2, AB 1 d. Gravida 3, para 3, AB 1
C
During the interview with a female patient, the nurse gathers data that indicate that the patient is perimenopausal. Which of the following statements made by this patient leads to this conclusion?
a.
“I have noticed that my muscles ache at night when I go to bed.”
b.
“I will be very happy when I can stop worrying about having a period.”
c.
“I have been noticing that I sweat a lot more than I used to, especially at night.”
d.
“I have only been pregnant twice, but both times I had breast tenderness as my first symptom.”
C
A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts, and wonders if they could be due to the estrogen replacement therapy she started 3 months ago. The nurse should tell her:
a.
“Estrogen replacement therapy is at such a low dose that side effects are very unusual.”
b.
“Estrogen replacement therapy has several side effects, including fluid retention, breast tenderness or enlargement, and vaginal bleeding.”
c.
“It would be very unusual to have breast tenderness with estrogen replacement therapy, and I suggest you contact your doctor immediately to have this evaluated.”
d.
“It sounds as if your dose of estrogen is too high. I think you should decrease the amount you are taking, and should call me back in a month to let me know how you’re feeling.”
B
A 52-year-old patient states that when she sneezes or coughs, she “wets herself a little.” She is very concerned that something may be wrong with her. The nurse knows that the problem is:
a.
hematuria, and usually needs to be evaluated by a urologist.
b.
stress incontinence, and is usually due to muscle weakness.
c.
true urinary incontinence, and may mean that she has a kidney infection.
d.
urgency incontinence, and she should empty her bladder before she sneezes or coughs.
B
During the interview, a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse’s most appropriate response to this would be:
a.
“Oh, don’t worry. Some cyclic vaginal discharge is normal.”
b.
“Have you been engaging in unprotected sexual intercourse?”
c.
“I’d like some information about the discharge. What colour is it?”
d.
“Have you had any urinary incontinence associated with the discharge?”
C
A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse must make sure to ask:
a.
“Have you noticed a change in your vaginal pH?”
b.
“Have you noticed any excessive vaginal bleeding?”
c.
“Have you noticed any unusual vaginal discharge or itching?”
d.
“Have you noticed any changes in your desire for intercourse?”
C
Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview?
a.
“Now, it’s time to talk about your sexual history. When did you first have intercourse?”
b.
“Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?”
c.
“Often women have questions about their sexual relationships and how they affect their health. Do you?”
d.
“Most women your age have had more than one sexual partner. How many would you say you have had?”
C
A 22-year-old woman has been considering using oral contraceptives. As a part of her history, the nurse should ask:
a.
“Do you have a history of heart murmurs?”
b.
“Will you be in a monogamous relationship?”
c.
“I wonder if you have thought this choice through carefully.”
d.
“If you smoke, how many cigarettes do you smoke per day?”
D
A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 6 months, and have not been successful. What should the nurse do first?
a.
Ascertain whether either of them has been using broad-spectrum antibiotics.
b.
Explain that couples are considered infertile after 1 year of unprotected intercourse.
c.
Immediately refer the woman to an expert in pelvic inflammatory disease (the most common cause of infertility).
d.
Explain that couples are considered infertile after 6 months of engaging in unprotected intercourse, and that they will need a referral to a fertility expert.
B
A nurse is assessing a patient’s risk of contracting a sexually transmitted infection (STI). An appropriate question would be:
a.
“You use condoms, don’t you?”
b.
“Do you use a condom at each episode of sexual intercourse?”
c.
“Do you have an STI?”
d.
“You are aware of the dangers of unprotected sex, aren’t you?”
B
When the nurse is interviewing a preadolescent girl, which of the following opening statement would be least threatening?
a.
“Do you have any questions about growing up?”
b.
“What has your mother told you about growing up?”
c.
“When did you notice that your body was changing?”
d.
“I remember being very scared when I got my period. How do you think you’ll feel?”
C
When the nurse is discussing sexuality and sexual issues with adolescents, a permission statement helps to convey that it is normal to think or feel a certain way. Which of the following is the best example of a permission statement?
a.
“It’s okay that you have become sexually active.”
b.
“Often girls your age have questions about sexual activity. Do you?”
c.
“If it’s okay with you, I’d like to ask you some questions about your sexual history.”
d.
“Often girls your age engage in sexual activity. It’s okay to tell me if you have had intercourse.”
B
Which of the following statements is true with regard to the history of a postmenopausal woman?
a.
The nurse should ask a postmenopausal woman if she ever has vaginal bleeding.
b.
Once a woman reaches menopause, the nurse does not need to ask any further history questions.
c.
The nurse should screen for monthly breast tenderness.
d.
Postmenopausal women are not at risk for contracting sexually transmitted infections, and thus these questions can be omitted.
A
During the examination portion of a patient’s visit, she will be in the lithotomy position. Which of the following statements reflect some things that the nurse can do to make this more comfortable for her?
a.
Ask her to place her hands and arms behind her head.
b.
Elevate her head and shoulders to maintain eye contact.
c.
Allow her to choose to have her feet in the stirrups or have them resting side by side on the edge of the table.
d.
Allow her to keep her buttocks about 15 cm (6 in.) from the edge of the table to prevent her from feeling as if she will fall off.
B
An 18-year-old patient is having her first pelvic examination. It would be appropriate to:
a.
invite her mother to be present during the examination.
b.
avoid the lithotomy position this first time because it can be uncomfortable and embarrassing.
c.
raise the head of the examination table and give her a mirror so that she can view the exam.
d.
drape her fully, leaving the drape between her legs elevated to avoid embarrassing her with eye contact.
C
The nurse has just completed an inspection of a woman’s external genitalia. Which of the following describes a finding within normal limits?
a.
Redness of the labia majora
b.
Multiple nontender sebaceous cysts
c.
Discharge that is sticky and yellow-green
d.
Swelling of the perineum before onset of menses
B
The order of examination of the internal genitalia is important. The nurse will use which order of examination at this time?
a.
Bimanual examination, speculum examination, rectovaginal examination
b.
Speculum examination, rectovaginal examination, bimanual examination
c.
Speculum examination, bimanual examination, rectovaginal examination
d.
Rectovaginal examination, bimanual examination, speculum examination
C
During an internal examination of a woman’s genitalia, the nurse will use which technique for proper insertion of the speculum?
a.
Instruct the woman to bear down, open the speculum blades, and apply in a swift, upward movement.
b.
Insert the blades of the speculum on a horizontal plane, turning them to a 45-degree angle while continuing to insert them. Ask the woman to bear down to ease insertion.
c.
Push the introitus down and open, instruct the woman to bear down, and insert the speculum with the width of the blades at an oblique angle, applying any pressure downward.
d.
Lock the blades open by turning the thumbscrew. Once the blades are open, apply pressure to the introitus and insert the blades at a 45-degree angle downward to bring the cervix into view.
C
The nurse is examining a 35-year-old female patient. During the history, the nurse notes that she has had two term pregnancies, with both babies delivered vaginally. The nurse observes the following on internal examination: the cervical os is a horizontal slit with some healed lacerations; the cervix has some nabothian cysts that are small, smooth, and yellow; the cervical surface is granular and red, especially around the os; and the presence of stringy, opaque, odorless secretions. Which of these findings are abnormal? a. The presence of nabothian cysts b. The cervical os is a horizontal slit c. The cervical surface is granular and red d. The presence of stringy and opaque secretions
C
A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse would be:
a.
“If you are menstruating, please use pads to avoid placing anything into the vagina.”
b.
“Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.”
c.
“If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you.”
d.
“We would like you to use a mild saline douche before your examination. You may pick this up in our office.”
B
Which of the following tests are usually collected when screening for cervical cancer?
a.
Endocervical specimen, cervical scrape, and vaginal pool
b.
Endocervical specimen, vaginal pool, and acetic acid wash
c.
Endocervical specimen, KOH prep, and acetic acid wash
d.
Cervical scrape, acetic acid wash, and saline mount (“wet prep”)
A
In performing the bimanual examination, the nurse notes that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. Which of the following should be the nurse’s interpretation of these results?
a.
These findings are all within normal limits.
b.
The cervical consistency should be soft and velvety, not firm.
c.
The cervix should move when palpated; an immobile cervix may indicate malignancy.
d.
It is unusual to have pain when the cervix is palpated, but the rest of the findings are within normal limits.
C
The nurse is palpating a female patient’s adnexa. The findings include a firm, smooth uterine wall, palpable ovaries that feel smooth and firm, and a fallopian tube that is firm and pulsating. The nurse’s most appropriate course of action would be to:
a.
tell the patient that her examination was normal.
b.
give the patient an immediate referral to a gynecologist.
c.
suggest that the patient return in a month for a recheck to verify the findings.
d.
tell the patient that she may have an ovarian cyst that should be evaluated further.
B
A 65-year-old woman is visiting the office for routine gynecological care. She had a complete hysterectomy 3 months ago. The nurse knows that which of the following statements is true with regard to this visit?
a.
Her cervical mucosa will be red and look dry.
b.
She will not have a cervix, and thus does not need to have a Pap smear done.
c.
The nurse can expect to find that her uterus will be somewhat enlarged, and her ovaries will be small and hard.
d.
The nurse should plan to lubricate the instruments and the examining hand well in order to avoid a painful examination.
D
The nurse is preparing to examine the external genitalia of a school-age girl. Which of the following positions would be most appropriate in this situation?
a.
In the parent’s lap
b.
In a frog-leg position on the examining table
c.
In the lithotomy position with the feet in stirrups
d.
Lying flat on the examining table with legs extended
B
When assessing a newborn infant’s genitalia, the nurse notes that the genitalia are somewhat engorged. The labia majora are swollen, the clitoris looks large, and the hymen is thick. The vaginal opening is difficult to visualize. The infant’s mother states that she is worried about the labia being swollen. The nurse should reply:
a.
“This is a normal finding in newborns, and should resolve within a few weeks.”
b.
“This could possibly indicate an abnormality, and may need to be evaluated by a physician.”
c.
“We will need to have estrogen levels evaluated to make sure that they are within normal limits.”
d.
“We will need to keep close watch over the next few days to see if the genitalia decrease in size.”
A
During a vaginal examination of a 38-year-old woman, the nurse notes that the vulva and vagina are erythematous and edematous, with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which of the following? a. Candidiasis b. Trichomoniasis c. Atrophic vaginitis d. Bacterial vaginosis
A
A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the nurse notes clusters of small, shallow vesicles with surrounding erythema on the labia. There is also inguinal lymphadenopathy present. The most likely cause of these lesions is: a. pediculosis pubis. b. contact dermatitis. c. human papillomavirus. d. herpes simplex virus type 2.
D
When performing an external genitalia examination for a 10-year-old girl, the nurse notes no pubic hair, and that the mons and the labia are covered with fine vellus hair. These findings are consistent with which stage of sexual maturity, according to the Sexual Maturity Rating scale? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4
A
A 46-year-old woman is in the clinic for her annual gynecological examination. She voices a concern about ovarian cancer, because her mother and sister died of it. The nurse knows that which of the following statements is correct regarding ovarian cancer?
a.
Ovarian cancer is manifested by severe abdominal pain.
b.
The Pap smear detects the presence of ovarian cancer.
c.
Women over 40 years of age should have a thorough pelvic examination every year.
d.
Women over 40 years of age should have a thorough pelvic examination every 3 years.
C
During a bimanual examination, the nurse detects a solid tumour on the patient’s ovary that is heavy and fixed, with a poorly defined mass. This finding is suggestive of: a. an ovarian cyst. b. endometriosis. c. ovarian cancer. d. an ectopic pregnancy.
C
A 25-year-old woman comes to the emergency department with a sudden fever of 38°C and abdominal pain. Upon examination, the nurse notes that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. The nurse knows that these signs and symptoms are suggestive of: a. endometriosis. b. uterine fibroids. c. ectopic pregnancy. d. pelvic inflammatory disease.
D
During a female external genitalia examination, the nurse notes several lesions around the woman’s vulva. The lesions are pink, moist, soft, pointed papules. The patient states that she is not aware of any problems in that area. The nurse recognizes that these lesions may be:
a.
syphilitic chancre.
b.
herpes simplex virus type 2 (herpes genitalis).
c.
human papillomavirus (HPV), or genital warts.
d.
pediculosis pubis (crab lice).
C
During an examination, the nurse would expect the cervical os of a woman who has never had children to appear: a. stellate. b. small and round. c. as a horizontal irregular slit. d. everted.
B
A woman has just been diagnosed with HPV, or genital warts. The nurse should counsel her to receive regular examinations, because this virus makes her at a higher risk for: a. uterine cancer. b. cervical cancer. c. ovarian cancer. d. endometrial cancer.
B
Which of the following statements about the anal canal is true?
a.
The anal canal is about 2 cm long in the adult.
b.
The anal canal slants backward toward the sacrum.
c.
The anal canal contains hair and sebaceous glands.
d.
The anal canal is the outlet for the gastrointestinal tract.
D
Which of the following statements about the sphincters is true?
a.
The internal sphincter is under voluntary control.
b.
The external sphincter is under voluntary control.
c.
Both sphincters remain slightly relaxed at all times.
d.
The internal sphincter surrounds the external sphincter.
B
The nurse is performing an examination of the anus and rectum. Which of the following is important to remember during this examination?
a.
The rectum is about 8 cm long.
b.
The anorectal junction cannot be palpated.
c.
Above the anal canal, the rectum turns anteriorly.
d.
There are no sensory nerves in the anal canal or rectum.
B
The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm is the: a. Cowper’s gland. b. prostate gland. c. median sulcus. d. seminal vesicle.
B
A 46-year-old man requires assessment of his sigmoid colon. Which of the following is most appropriate for this examination? a. A proctoscope b. An ultrasound c. A colonoscope d. A rectal exam with an examining finger
C
The nurse is caring for a newborn infant. Thirty hours after birth, the infant passes a dark green meconium stool. The nurse recognizes that this is important because:
a.
this stool would indicate anal patency.
b.
the dark green colour could indicate occult blood in the stool.
c.
meconium stool can be reflective of distress in the newborn.
d.
the newborn should have passed the first stool within 12 hours after birth.
A
During the assessment of an 18-month-old, the mother expresses concern to the nurse about the infant’s inability to toilet train. What would be the nurse’s best response?
a.
“Some children are just more difficult to train, so I wouldn’t worry about it yet.”
b.
“Have you considered reading any of the books on toilet training? They can be very helpful.”
c.
“This could mean there is a problem in your baby’s development. We’ll watch her closely for the next few months.”
d.
“The nerves that will allow your baby to have control over the passing of stools are not developed until at least 18 to 24 months of age.”
D
A 60-year-old man has just been told he has benign prostatic hypertrophy. He has a friend who just died from prostate cancer, and is concerned this will happen to him. How should the nurse respond?
a.
“The swelling in your prostate is only temporary, and will go away.”
b.
“We will treat you with chemotherapy so we can control the cancer.”
c.
“It would be very unusual for a man your age to have prostate cancer.”
d.
“The enlargement of your prostate is caused by hormone changes and not cancer.”
D
A 30-year-old woman is visiting the clinic for a complaint of “pain in my bottom when I have a bowel movement.” The nurse should assess for which problem? a. Pinworms b. Hemorrhoids c. Food poisoning d. Fecal incontinence
B
A patient who is visiting the clinic complains of having “stomach pains for 2 weeks” and describes his stools as being “soft and black” for about the last 10 days. He denies taking any medications. The nurse is aware that these symptoms are most indicative of:
a.
excessive fat caused by malabsorption.
b.
increased iron intake resulting from a change in diet.
c.
occult blood resulting from gastrointestinal bleeding.
d.
increase in bile pigment from liver problems.
C
After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses early detection measures for colon cancer with him. The nurse is sure to mention the need for a(n): a. annual proctoscopy. b. colonoscopy every 5 years. c. fecal test for blood every 2 years. d. digital rectal examination every 2 years.
B
The mother of a 5-year-old girl tells the nurse that she has noticed her daughter “scratching at her bottom a lot the last few days.” During the assessment, the nurse finds redness and raised skin in the anal area. This most likely indicates: a. pinworms. b. chickenpox. c. child abuse. d. bacterial infection.
A
The nurse is examining only the rectal area of a woman. In what position should the woman be placed? a. The lithotomy position b. Lying in the prone position c. The left lateral decubitus position d. Bending over the table while standing
C
While doing an assessment of the perianal area of a patient, the nurse notes that the pigmentation of the anus is darker than the surrounding skin, that the anal opening is closed, and the presence of a skin sac that is shiny and blue. The patient mentions that he has had pain with bowel movements, and has noted some occasional spots of blood. What would this assessment and history most likely indicate? a. Anal fistula b. Pilonidal cyst c. Rectal prolapse d. Thrombosed hemorrhoid
D
Which of the following techniques is correct for palpation of the rectum?
a.
Flex the finger and insert slowly toward the umbilicus.
b.
First instruct the patient that this will be a painful procedure.
c.
Insert an extended index finger at a right angle to the anus.
d.
Place the finger directly into the anus to overcome the tight sphincter.
A
While performing a rectal examination, the nurse notes a firm, irregularly shaped mass. What should the nurse do next?
a.
Continue with the exam, and note the finding in the chart.
b.
Instruct the patient to return for a repeat assessment in 1 month.
c.
Tell the patient that a mass was felt, but that it is nothing to worry about.
d.
Report the finding, and refer the patient to a specialist for further examination.
D
When testing stool for occult blood, the nurse is aware that a false-positive result may occur with: a. absent bile pigment. b. increased fat content. c. increased ingestion of iron medication. d. a large amount of red meat within the last 3 days.
D
During an assessment of the newborn, the nurse expects to see which finding when the anal area is slightly stroked? a. A jerking of the legs b. Flexion of the knees c. A quick contraction of the sphincter d. Relaxation of the external sphincter
C
During an assessment of a 20-year-old man, the nurse finds a small, palpable lesion, containing a tuft of hair, located directly over the coccyx. The nurse knows that this lesion would most likely be a: a. polyp. b. pruritus ani. c. benign tumour. d. pilonidal cyst.
D
During an examination, the nurse asks the patient to perform the Valsalva manoeuvre and notes that the patient has a moist, red, doughnut-shaped protrusion from the anus. The nurse knows that this would be consistent with: a. a rectal polyp. b. hemorrhoids. c. a rectal fissure. d. rectal prolapse.
D
A 70-year-old man is visiting the clinic for “difficulty in passing urine.” In the history, he indicates he has to urinate frequently, especially at night. He experiences burning when he urinates, and has noticed pain in his back. Given this history, what might the nurse expect to find during the physical assessment?
a.
Asymmetric, hard, fixed prostate gland
b.
Occult blood and perianal pain with palpation
c.
Symmetrically enlarged, soft prostate gland
d.
A soft nodule protruding from rectal mucosa
A
A 40-year-old male of African descent is in the office for his annual physical. Which statement is true regarding screening for prostate cancer, according to the Canadian Cancer Society?
a.
DRE is more effective than PSA in finding prostate cancer.
b.
Ancestry is a factor in determining when PSA testing begins.
c.
PSA will be done at 50 years of age if there is a family history.
d.
BPH increases an individual’s risk for prostate cancer.
B
A 62-year-old man is experiencing fever, chills, malaise, and urinary frequency and urgency. He also reports urethral discharge and a dull, aching pain in the perineal and rectal area. These symptoms are most consistent with which of the following? a. Prostatitis b. Urinary tract infection c. Carcinoma of the prostate d. Benign prostatic hypertrophy
A
Which of the following is an abnormal finding upon palpation of the prostate gland through the rectum? a. Palpable central groove b. Tenderness to palpation c. Heart shape d. Elastic and rubbery consistency
B
The nurse notes that a patient has had a pale, yellow, greasy stool, or steatorrhea, and recalls that this is caused by: a. occult bleeding. b. absent bile pigment. c. increased fat content. d. ingestion of bismuth preparations.
C
During a health history of a patient who complains of chronic constipation, she asks the nurse about high-fibre foods. The nurse relates that an example of a high-fibre food would be: a. broccoli. b. hamburger. c. iceberg lettuce. d. white dinner rolls.
A
While assessing a hospitalized, bedridden patient, the nurse notes that the patient has been incontinent of stool. The stool is loose and grey-tan in colour. The nurse recognizes that this finding indicates which of the following? a. Occult blood b. Inflammation c. Absent bile pigment d. Ingestion of iron preparations
C
During a digital examination of the rectum, the nurse notes that the patient has hard feces in the rectum. The patient complains of feeling “full,” has a distended abdomen, and states that she has not had a bowel movement “for several days.” The nurse suspects which condition? a. Rectal polyp b. Fecal impaction c. Rectal abscess d. Rectal prolapse
B
The nurse is performing a digital examination of a patient’s prostate gland, and notes a normal prostate gland includes the following characteristics: Select all that apply.
a.
The gland is protruding 1 cm into the rectum.
b.
The gland is heart-shaped, with a palpable central groove.
c.
The gland is flat, with no palpable groove.
d.
The gland has a boggy and soft consistency.
e.
The gland has a smooth surface, and an elastic or rubbery consistency.
f.
The gland has fixed mobility.
A,B,E
The external male genital structures include the: a. testis. b. scrotum. c. epididymis. d. vas deferens.
B
An accessory glandular structure for the male genital organs is the: a. testis. b. penis. c. prostate. d. vas deferens.
C
Which of the following statements is true regarding the penis?
a.
The urethral meatus is located on the ventral side of the penis.
b.
The prepuce is the fold of foreskin covering the shaft of the penis.
c.
The penis is composed of two cylindrical columns of erectile tissue.
d.
The corpus spongiosum expands into a cone of erectile tissue called the glans.
D
When performing a genital examination on a 25-year-old man, the nurse notes deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the nurse would:
a.
squeeze the glans, checking for the presence of discharge.
b.
consider this a normal finding, and proceed with the examination.
c.
assess the testicles for the presence of masses or painless lumps.
d.
obtain a more detailed health history, focusing on any scrotal abnormalities the patient has noticed.
B
Which of the following statements about the testes is true?
a.
The lymphatics of the testes drain into the abdominal lymph nodes.
b.
The vas deferens is located along the inferior portion of each testis.
c.
The right testis is lower than the left because the right spermatic cord is longer.
d.
The cremaster muscle contracts in response to cold, and draws the testicles closer to the body.
D
A male patient with possible fertility problems asks the nurse where sperm is produced. The nurse knows that sperm production occurs in the: a. testes. b. prostate. c. epididymis. d. vas deferens.
A
A 62-year-old man states that his doctor told him that he has an “inguinal hernia.” He asks the nurse to explain what a hernia is. The nurse should:
a.
tell him not to worry, since most men his age develop hernias.
b.
explain that a hernia is often the result of prenatal growth abnormalities.
c.
refer him to his physician for additional consultation, because the physician made the initial diagnosis.
d.
explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.
D
The mother of a 10-year-old boy asks the nurse to discuss how puberty can be recognized. The nurse should reply:
a.
“Puberty usually begins at about age 15.”
b.
“The first sign of puberty is enlargement of the testes.”
c.
“Penis size does not increase until about the age of 16.”
d.
“The development of pubic hair precedes testicular or penis enlargement.”
B
During an examination of an aging male, the nurse recognizes that a normal, expected change would be: a. premature ejaculation. b. declining testosterone production. c. difficulty in maintaining an erection. d. a decreased refractory state after ejaculation.
B
An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a withdrawal from sexual activity later in life may be due to: a. side effects of medications. b. decreased libido with aging. c. decreased sperm production. d. decreased pleasure from sexual intercourse.
A
A newborn baby boy is about to have a circumcision. The nurse knows that indications for circumcision include: a. cultural beliefs. b. prevention of testicular cancer. c. improving the sperm count later in life. d. preventing the transmission of human immunodeficiency virus during sexual intercourse.
A
A 59-year-old patient has been diagnosed with prostatitis, and is being seen at the clinic for complaints of burning and pain during urination. He is experiencing: a. dysuria. b. nocturia. c. polyuria. d. hematuria.
A
A 45-year-old carpenter is seen at the clinic for a complaint of “losing my urine when I lift heavy objects.” He is experiencing: a. frequency. b. urinary hesitancy. c. stress incontinence. d. urgency incontinence.
C
When the nurse is conducting a sexual history for a male adolescent, which statement would be most appropriate to use at the beginning of the interview? a. “Do you use condoms?” b. “You don’t masturbate, do you?” c. “Have you had sex in the last 6 months?” d. “Often boys your age have questions about sexual activity.”
D
Which of the following statements is most appropriate when the nurse is obtaining a genitourinary history from an elderly man?
a.
“Do you need to get up at night to urinate?”
b.
“Do you experience nocturnal emissions, or ‘wet dreams’?”
c.
“Do you know how to perform testicular self-examination?”
d.
“Has anyone ever touched your genitals when you did not want them to?”
A
While the nurse is performing a genital examination on a male patient, the patient has an erection. The nurse’s most appropriate action or response is to:
a.
ask the patient if he would like someone else to examine him.
b.
continue with the examination as though nothing has happened.
c.
stop the examination, state that the examination will resume at a later time, and leave the room.
d.
reassure the patient that this is a normal response, and continue with the examination.
D
The nurse knows that which of the following is a normal finding when examining the glans?
a.
The dorsal vein may be visible.
b.
Hair is without pest inhabitants.
c.
The skin is wrinkled and without lesions.
d.
Smegma may be present under the foreskin of an uncircumcised male.
A
When performing a genitourinary assessment, the nurse notes that the urethral meatus is positioned ventrally. This finding is: a. called hypospadius. b. the result of phimosis. c. probably due to a stricture. d. often associated with aging.
A
The nurse is performing a genital examination on a male patient, and notes urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should:
a.
ask the patient to urinate into a sterile cup.
b.
ask the patient to obtain a specimen of semen.
c.
insert a cotton-tipped applicator into the urethra.
d.
compress the glans between the examiner’s thumb and forefinger, and collect any discharge.
D
When assessing the scrotum of a male patient, the nurse notes the presence of multiple firm, nontender, yellow, 1-cm nodules. The nurse knows that these nodules are most likely: a. from urethritis. b. sebaceous cysts. c. subcutaneous plaques. d. from inflammation of the epididymis.
B
When performing a scrotal assessment, the nurse notes that the scrotal contents transilluminate and show a red glow. On the basis of this finding, the nurse would:
a.
assess the patient for the presence of a hernia.
b.
suspect the presence of serous fluid in the scrotum.
c.
consider this a normal finding, and proceed with the examination.
d.
refer the patient for evaluation of a possible mass in the scrotum.
B
When the nurse is performing a genital examination on a male patient, which of the following actions is correct?
a.
Auscultate for the presence of bowel sounds over the scrotum.
b.
Palpate for the vertical chain of lymph nodes along the groin inferior to the inguinal ligament.
c.
Palpate the inguinal canal only if there is a bulge present in the inguinal region during inspection.
d.
Have the patient shift his weight onto the left (unexamined) leg when palpating for a hernia on the right side.
D
The nurse is aware that which of the following statements is true regarding the incidence of testicular cancer?
a.
Testicular cancer is the most common cancer in men aged 30–50 years.
b.
The early symptoms of testicular cancer are pain and induration.
c.
Men with a history of cryptorchidism are at greatest risk for development of testicular cancer.
d.
Men of European descent are four times more likely to develop testicular cancer than men of non-European descent.
C
The nurse is describing how to perform a testicular self-examination to a patient. Which of the following statements is most appropriate?
a.
“A good time to examine your testicles is just before you take a shower.”
b.
“If you notice an enlarged testicle or a painless lump, call your health care provider.”
c.
“The testicle is egg shaped and movable. It feels firm and has a lumpy consistency.”
d.
“Perform a testicular exam at least once a week to detect the early stages of testicular cancer.”
B
A 2-month-old uncircumcised boy has been brought to the clinic for a well-baby checkup. How would the nurse proceed with his genital examination?
a.
Elicit the cremasteric reflex.
b.
Assess the glans for redness or lesions.
c.
Avoid retracting the foreskin until the infant is 3 months old.
d.
Note any dirt or smegma that has collected under the foreskin.
C
A 2-year-old boy has been diagnosed with “physiological cryptorchidism.” Given this diagnosis, during assessment, the nurse will most likely observe:
a.
testes that are hard and painful to palpation.
b.
an atrophic scrotum and absence of the testis bilaterally.
c.
an absence of the testis in the scrotum, but the testis can be milked down.
d.
testes that migrate into the abdomen when the child squats or sits cross-legged.
C
The nurse knows that a common assessment finding in a boy under 2 years old is:
a.
an inflamed and tender spermatic cord.
b.
the presence of a hernia in the scrotum.
c.
a penis that looks large in relation to the scrotum.
d.
the presence of a hydrocele, or fluid in the scrotum.
D
During an examination of an aging male, the nurse recognizes that a normal, expected change would be: a. a change in scrotal colour. b. a decrease in the size of the penis. c. enlargement of the testes and scrotum. d. an increase in the number of rugae over the scrotal sac.
B
When performing a genital assessment on a 34-year-old man, the nurse notes cauliflower-like patches of multiple soft, moist, painless scattered across the shaft of the penis. These lesions are characteristic of: a. carcinoma. b. syphilitic chancres. c. herpes progenitalis. d. genital warts
D
A 15-year-old boy is seen in the clinic for a complaint of “dull pain and pulling” in the scrotal area. On examination, the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with: a. epididymitis. b. spermatocele. c. testicular torsion. d. a spermatic cord varicocele.
D
When performing a genitourinary assessment on a 16-year-old boy, the nurse notices a swelling in the scrotum that increases with intensified intra-abdominal pressure and decreases when he is lying down. The patient complains of pain when straining. The nurse knows that this description is most consistent with a(n): a. femoral hernia. b. incisional hernia. c. direct inguinal hernia. d. indirect inguinal hernia.
D
Which of the following findings is considered normal when the nurse is performing a testicular examination on a 25-year-old man?
a.
Nontender subcutaneous plaques
b.
A scrotal area that is dry, scaly, and nodular
c.
Testes that feel oval and movable, and are slightly sensitive to compression
d.
A single, hard, circumscribed, movable mass, less than 1 cm under the surface of the testes
C
The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation?
a.
The skin on the scrotum is shiny and smooth.
b.
The left testicle hangs lower than the right testicle.
c.
The scrotum is a darker colour than the general skin colour.
d.
The testes move closer to the body in response to cold temperatures.
A
A 55-year-old man is experiencing severe, sudden onset pain onset in the scrotal area. It is somewhat relieved by elevation. On examination, the nurse notes an enlarged, red scrotum that is very tender to palpation. It is difficult to distinguish the epididymis from the testis, and the scrotal skin is thick and edematous. This description is consistent with which of the following? a. Varicocele b. Epididymitis c. Spermatocele d. Testicular torsion
B
The nurse is performing a genitourinary assessment on a 50-year-old obese male labourer. On examination, the nurse notes a painless round swelling close to the pubis, in the area of the internal inguinal ring, which is easily reduced when the individual is supine. These findings are most consistent with which of the following conditions? a. A scrotal hernia b. A femoral hernia c. A direct inguinal hernia d. An indirect inguinal hernia
C
Prolonged, painful erection of the penis without sexual desire is known as: a. orchitis. b. stricture. c. phimosis. d. priapism.
D
During an examination, the nurse notes that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. At this point the nurse suspects that this patient has: a. genital warts. b. a herpes infection. c. a syphilitic chancre. d. a carcinoma lesion.
C
During a health history, a patient tells the nurse that he has trouble in starting his urine stream. This problem is known as: a. urgency. b. dribbling. c. frequency. d. hesitancy.
D
During a genital examination, the nurse notes that a male patient has clusters of small vesicles on his glans, surrounded by erythema. The nurse recognizes that these lesions are: a. Peyronie’s disease. b. genital warts. c. genital herpes. d. syphilitic cancer.
C
During a physical examination, the nurse finds that a male patient’s foreskin is fixed and tight, and will not retract over the glans. The nurse recognizes that this condition is: a. phimosis. b. epispadias. c. urethral stricture. d. Peyronie’s disease.
A
The two parts of the nervous system are: a. motor and sensory. b. central and peripheral. c. peripheral and autonomic. d. hypothalamus and cerebral.
B
The wife of a 65-year-old man tells the nurse that she is concerned because she has noted a change in her husband’s personality and ability to understand. He also cries and becomes angry very easily. The nurse recalls that the cerebral lobe responsible for these behaviours is which of the following? a. Frontal b. Parietal c. Occipital d. Temporal
A
Which of the following statements concerning areas of the brain is accurate?
a.
The cerebellum is the center for speech and emotions.
b.
The hypothalamus controls temperature and regulates sleep.
c.
The basal ganglia are responsible for controlling voluntary movements.
d.
Motor pathways of the spinal cord and brainstem synapse in the thalamus.
B
The area of the nervous system that is responsible for mediating reflexes is the: a. medulla. b. cerebellum. c. spinal cord. d. cerebral cortex.
C
While gathering equipment for an intravenous injection, a nurse accidentally received a prick from an improperly capped needle. To interpret this sensation, which of the following areas must be intact?
a.
Corticospinal tract, medulla, and basal ganglia
b.
Pyramidal tract, hypothalamus, and sensory cortex
c.
Lateral spinothalamic tract, thalamus, and sensory cortex
d.
Anterior spinothalamic tract, basal ganglia, and sensory cortex
C
A patient with a lack of oxygen to his heart will have pain in his chest, and also possibly in his shoulders, arms, or jaw. Which of the following best explains why this occurs?
a.
There is a problem with the sensory cortex and its ability to discriminate the location.
b.
The lack of oxygen in his heart has resulted in decreased amount of oxygen to these areas.
c.
The sensory cortex does not have the ability to localize pain in the heart, so the pain is felt elsewhere.
d.
There is a lesion in the dorsal root that is preventing the sensation from being transmitted normally.
C
The human ability to perform very skilled movements such as writing is controlled by the: a. basal ganglia. b. corticospinal tract. c. spinothalamic tract. d. extrapyramidal tract.
B
A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. With these findings, which area of the brain would concern the nurse? a. Thalamus b. Brainstem c. Cerebellum d. Extrapyramidal tract
C
Which of the following statements about the peripheral nervous system is correct?
a.
The cranial nerves enter the brain through the spinal cord.
b.
Efferent fibres carry sensory input to the central nervous system through the spinal cord.
c.
The peripheral nerves are inside the central nervous system and carry impulses through their motor fibres.
d.
The peripheral nerves carry input to the central nervous system by afferent fibres and away by efferent fibres.
D
A patient has a severed spinal nerve as a result of trauma. Which of the following statements is true in this situation?
a.
Because there are 31 pairs of spinal nerves, there is no effect if only one is severed.
b.
The dermatome served by this nerve will no longer experience any sensation.
c.
The adjacent spinal nerves will continue to carry sensations for the dermatome served by the severed nerve.
d.
This will only affect the motor function of the patient, because spinal nerves have no sensory component.
C
A 21-year-old patient has a head injury resulting from trauma, and is unconscious. There are no other injuries. During the assessment, what would the nurse expect to find when testing the patient’s deep tendon reflexes?
a.
Reflexes will be normal.
b.
Reflexes will not be able to be elicited.
c.
All reflexes would be diminished, but present.
d.
Some reflexes would be present, depending on the area of injury.
A
A mother of a 1-month-old infant asks the nurse why it takes so long for babies to learn to roll over. The nurse knows that the reason for this is that:
a.
there must be a demyelinating process occurring with the baby.
b.
myelin is needed to conduct these impulses, and the neurons of a newborn are not myelinated.
c.
the cerebral cortex is not fully developed, so control over motor function occurs gradually.
d.
the spinal cord is controlling the movement because the cerebellum is not yet fully developed.
B
During an assessment of an 80-year-old patient, the nurse notes the patient’s inability to identify vibrations at the ankle and to identify the position of the big toe; a slower and more deliberate gait; and slightly impaired tactile sensation. All other neurological findings are normal. The nurse knows that these findings indicate: a. cranial nerve dysfunction. b. a lesion in the cerebral cortex. c. normal changes due to aging. d. demyelinization of nerves due to a lesion.
C
A 70-year-old woman tells the nurse that every time she gets up in the morning or after she’s been sitting, she gets “really dizzy” and feels like she is going to “fall over.” The nurse’s best response would be:
a.
“Have you been extremely tired lately?”
b.
“You probably just need to drink more liquids.”
c.
“I’ll refer you for a complete neurological examination.”
d.
“You need to get up slowly when you’ve been lying or sitting.”
D
During the history, a patient tells the nurse that “it feels like the room is spinning around me.” The nurse would document this as: a. vertigo. b. syncope. c. dizziness. d. seizure activity.
A
When doing the history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. Which of the following would be the best question to ask in order to obtain this information?
a.
“Does your muscle tone seem tense or limp?”
b.
“After the seizure, do you spend a lot of time sleeping?”
c.
“Do you have any warning sign before your seizure starts?”
d.
“Do you experience any colour change or incontinence during the seizure?”
C
While obtaining a history of a 3-month old infant from its mother, the nurse asks about the baby’s ability to suck and grasp the mother’s finger. What is the nurse assessing? a. Reflexes b. Intelligence c. Cranial nerves d. Cerebral cortex function
A
In obtaining a history for a 74-year-old patient, the nurse notes that he drinks alcohol daily, and that he has noticed a tremor in his hands that affects his ability to hold things. With this information, what should the nurse’s response be?
a.
“Does your family know you are drinking every day?”
b.
“Does the tremor change when you drink the alcohol?”
c.
“We’ll do some tests to see what is causing the tremor.”
d.
“You really shouldn’t drink so much alcohol; it may be causing your tremor.”
B
A 50-year-old woman is visiting the clinic for “weakness in my left arm and leg for the past week.” The nurse will perform which type of neurological examination? a. Glasgow Coma Scale b. Neurological recheck examination c. Screening neurological examination d. Complete neurological examination
D
During an assessment of a patient’s cranial nerves, the nurse finds a lack of blink in the right eye with corneal reflex; intact ability to sense light touch on the face; and loss of movement with facial features on the right side. This would indicate dysfunction of which of the following cranial nerves? a. Motor component of IV b. Motor component of VII c. Motor and sensory components of XI d. Motor component of X and sensory component of VII
B
The nurse is testing the function of cranial nerve XI. Which of the following best describes the response the nurse would expect if the nerve is intact?
a.
Demonstrates full range of motion of the neck
b.
Sticks tongue out midline without tremors or deviation
c.
Follows an object with the eyes without nystagmus or strabismus
d.
Moves the head and shoulders against resistance with equal strength
D
During the neurological assessment of a “healthy” 35-year-old patient, the nurse asks him to relax his muscles completely. The nurse then moves each extremity through the full range of motion. Which of the following would the nurse expect to find?
a.
Firm, rigid resistance to movement
b.
Mild, even resistance to movement
c.
Hypotonic muscles as a result of total relaxation
d.
Slight pain with some directions of movement
B
When the nurse asks a 68-year-old patient to stand with his feet together, his arms at his sides, and his eyes closed, he starts to sway and moves his feet further apart. The nurse would document this finding as a(n): a. ataxia. b. lack of coordination. c. negative Homan’s sign. d. positive Romberg’s sign.
D
The nurse is doing an assessment on a 29-year-old woman who visits the clinic complaining of “always dropping things and falling down.” While testing rapid alternating movements, the nurse notices that the woman is unable to pat both her knees. Her response is very slow, and she misses frequently. What might the nurse suspect? a. Vestibular disease b. A lesion of cranial nerve IX c. Dysfunction of the cerebellum d. Inability to understand directions
C
The nurse is taking the health history of a 78-year-old man. During the history, his wife states that he occasionally has problems with short-term memory loss and confusion: “He can’t even remember how to button his shirt.” In doing the assessment of his sensory system, the nurse would do which of the following?
a.
The nurse would not do this part of the examination because results would not be valid.
b.
The nurse would perform the tests, knowing that mental status does not affect sensory ability.
c.
The nurse would proceed with the explanations of each test, making sure the wife understands.
d.
Before testing, the nurse would assess the patient’s mental status and ability to follow directions at this time.
D
The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin to his arm several times, he is only able to identify these as one “very sharp prick.” What would be the most accurate explanation for this?
a.
The patient has hyperesthesia as a result of the aging process.
b.
This is most likely the result of the summation effect.
c.
The nurse was probably not poking hard enough with the pin in the other areas.
d.
The patient most likely has analgesia in some areas of his arm and hyperalgesia in others.
B
The nurse is performing a neurological assessment for a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notes that she is unable to feel vibrations on the great toe or ankle bilaterally, but is able to feel vibrations on both patellae. Given this information, what would the nurse suspect? a. Hyperalgesia b. Hyperesthesia c. Peripheral neuropathy d. Lesion of sensory cortex
C
The nurse places a key in the hand of a patient, and he identifies it as a penny. What term would the nurse use to describe this finding? a. Extinction b. Astereognosis c. Graphesthesia d. Tactile discrimination
B
